DR. WONG:
[DR. WALLACE WONG RECORDING]
[BEGINNING OF AUDIO]
•• relatives or someone that you know happen to be on the gender spectrum, just a raise a hand.
Okay. So quite an inventory. And how many just curious and want to learn more about this today?
Okay. Great. Okay. Good.
So I think that -- that when I got into this field, being. like, my residency, [indiscernible]
1996. So -- so I - that was my first practice
[indiscernible].
I was working in the Gay and Lesbian Centre. So even working by the early
"90s, that was the very -- a big thing going on is HIV and AIDS, right? So I was working in the AIDS Foundation Program, in which I was assigned to do therapy with the LGBTQ population. So what my role is. I will provide counselling for them and all those people who are HIV positive. So what's very interesting is the way I would see them, like, this week; a couple weeks later, I would not see them because they died.
So among those people I see, the gay and lesbian -• I mean, lesbian is not really the big an epidemic - the gay male, and in terms of, like, their family disown them, they won't go see them. So it's quite, quite traumatic that they're dying alone, right? But on top of that, I saw the worst group of population that were really dying in the hospital bed, and nobody will bother to go see them. And that is the transgender population. And being the naive, green, and don't know better, so I asked my supervisor, What's going on? What's going on with this population? There are so many people just like that. And then that is how I got my interest to get to work with this population to develop my curiosity and doing my research with this population.
And if you asked me 20 years ago, who would come see me who is transgendered, I would say it would be, like, 90 percent would be adults. So adult come see me, they would say, You know what, Dr. Wong, I need to transition. I need to have -- I need surgery and the hormones, all those things. Eventually, then I see the second wave. Then I see the older adolescents; they want to see me for transition. So they want to have -- go for, like, hormone. They want to go for surgery, different things.
Then I see the mid-adolescents. Then I'm talking about maybe someone that is, like, 14,
15, 16 to come see me. So there's a third wave I see.
And then after that, I see even younger now.
Then I would say that a lot more people coming to see me, they are, like, right about puberty or pre-puberty group come see me.
And then after that, and I thought that should be enough. Then I see the younger kids.
So the younger kid come see me as young as 3
years old. They will come see me. So I was
1ike ••
So you can see that it's all happening since
1996 to now. It's really about 20 years we're talking about, right? So it's really happening very fast. And the [indiscernible] in academic area, you know when you have to do the research, by the time you write the paper, you publish it.
it takes time, right? So -- so the research is not keeping up with this, because things are happening so fast.
So once there, we thought, Okay. We kind of get a hint of what's going on with this group of kids. Then now, we have another group of kids coming that's called gender non-binary. That means those would be all around the continuum, they would be somewhere. They become more sophisticated to .. and I pointed to them that, You know what? Gender is not just about male or female. There's a lot of gray area here. And what does that make me if I have feelings that is in the middle here? Because we all know that if you have the feeling, there's no name for that, those feelings are invalidated, right? It doesn't exist.
So a lot of times, the a kids now, they will come up with different names to describe where they are on the spectrum, such as gender queer.
gender non-binary, third gender, A-gender, demi-boy, demi-girl, and the list goes on.
And I think it's very interesting to find out about a definition about how they identify on that spectrum. And why that matters, we will talk about that later. So enough about me.
So I think let's start with the young kids that I'm working with, and hopefully I will have enough time to talk about other things. And I think what is happening, more younger children present with gender dysphoria and gender identify concern. And parents are also .- take a more active role in seeking appropriate care for their child with gender dysphoria.
Let's see -- I'm not good with technology at all. Okay. No. Okay. I got it. Okay. I got it. Did I get it? Okay. Good. So we're looking for. like, what would be the possible reason, and this is what we know so far. So we think with the available information through the media and social media have created a big .. an education and information bank. And I think it's good and bad.
Best thing about it that way, when a kid that, they know they have this kind of feelings.
and they will come and tell me and say. Well, I Googled those feelings, and bam, I go to that website and realize that I'm not alone. Yeah, a group of kids just like how I feel. And I think that is great. I think that's great because they know how they feel.
But the down side of it is, like, sometimes the kid, they will, Oh, this is how I feel. And the kids will start encouraging each other. Hey, look at my chest surgery, looks so good. That will be something that you should get too. And the kids will usually take on that. Hey. I should get too. They will get the surgeon name and tell me, Dr. Wong, I want to have chest surgery, and this is the doctor I want to have in Florida. I want you to send them a letter, all those things.
So it's good and bad, because I think that for information-wise, they got to know more, right? But at the same time, sometimes, some of the kids, they are somewhere on the spectrum.
They can be easily encouraged to one way or the other. That may not be where they're supposed to be. Does that make sense, right? Especially younger kids, right?
Because. like, we •- keep in mind, we live in a gender binary system. We only have two gender in this world. In the old days, that's how it was, right? If I don't feel like a boy, the only options that I have is a girl. And society has a way, in my unconscious mind, conditioning me, telling me what a girl is supposed to be.
So for a young kid, if I don't feel like a boy. I feel like a girl, there's only one way for me to know. I need to look like this. This is what I need to go after. So let's assume this is a model from Victoria's Secret. So I want to look like her. I need to be lush hair. I want to have like, I don't know, B-cup breasts, my waist probably as skinny as possible. And I need to be thick hairs. That will be good.
So they will idolizing the body image that they want to be, to be ideal .- ideal female.
At the same time, they also know that being transgender is •- many of them, they have kind of like, I feel I'm second class because I'm not natural birth female.
So what they say is, like, I want to be loved. I want to be wanted. I want to be accepted. I want to be able the same opportunity to be pursued by the people I love, just like this model, Victoria's Secret. So what should I do? I go after someone just like that.
So sometimes a kid will come tell me, when we're talking about the ideal body image, they will tell me the image that is so unnatural and obtainable (sic]. But for them, that will be a real man, or a real woman look like in their mind [sic]. Does that make sense?
So -- and then, I think also we have more open discussion about this population across the -- open the newspaper, the magazine, and they're already talking about this. It's something that they -- they will open talking about it, so I think because they hear about this. And I think that's good, that they're hearing.
But I think for parents to be mindful how your comment is when you see things like this on the news. Because a lot of times, the kids will come tell me, it's like, Oh, yeah. I don't tell my parents. I don't want to tell them. I hide my feelings because I heard them, the negative comment that they make when they saw some news about transgender people.
So kids, they do eardrop [sic], and we don't know which one of our kids will happen to be transgender. We have no control over that. We don't know which one of our kids will turn out to be LGBT. I mean, they're still lovely kids, but we need to be mindful of the words that we say, our conversation at home.
And then also learning that there's a way to change, and I think that is really interesting.
Many of the youth that I did assessment back then is, like, I've just depressed, I've been suicidal, because I think there's no way to change. Now, I have access to the internet. I know there's a way to change. I know there's steps for me to change. Of course, we're talking about -- they will say, Oh I want hormone blocker. I want hormone -- maybe that is for some, but that may not be for everyone.
So, and that -- they also -- there's a change of social norm. I think with the society more open about this, we are more accepting people. We're about diversity. We're .. and the LGBTQ population, I think the kids, they feel more comfortable and safer, and more support to come out.
So of course another one is available --
able to identify early on what the feeling was.
I think back then, I have those feelings, but I don't know what that means. I don't have the language for it.
Okay. There we go. So I think the outcome, what we see is children who surface is getting younger and younger, and the rate is increasing very fast. So the youngest patient that I have is two-and-three-quarters year old. So you can imagine, in someone that is just learning how to walk and learning how to talk, the first thing is not, Mommy, I love you. They say. Mommy, I'm not a boy; Mommy, I'm not a girl.
So I think that -- you can imagine how distressful that can be for the parents, was What are you going on? But the funny thing is, what research telling us, by three years old, we learn about the gender identity. So that's something that we know more recently. They know about, Hey, actually, they do know about the gender identity. They may not have the sophistication of language to explain this to us, but they will express it through their behaviour, through being difficult, they don't want to wear the dresses they're supposed to. They want to play the toy they're supposed to [sic]. The kid going, Mom, you shouldn't call me a girl; I'm a boy. That kind of thing.
So in our Gender Health Clinic, we start in two thousand -- after 2010. So back then, we started with four clients at the Ministry. But now, we have more than 500 kids, and just the Ministry alone. If I'm talking about my private practice altogether, we have -- I see more than
1,000. 1,000. So that's quite significant.
So in this 500 of them, so we're talking about in just, like, within ten years, that's 125
times increase. So we can imagine the demand of service is soaring. But for training professionals, it takes time, right? Between a resident, it takes a couple of years to do it.
The research, we're trying to keep up the pace.
but the phenomenon is happening a lot faster than -• than we expected.
So -- and as .. so I'm not going to take this again, promise. All right. So what we see, is we noticed children, they may push for earlier medication, transition. Parents, they feel pressure to act because their kid is so distressed. And professional also sometimes they feel pressure to make decisions that they may not feel comfortable with. For example, with
[indiscernible], her son's doctor, they feel like, Oh, they keep coming. So I just need to give them what they need, but they did not do a thorough, detailed assessment, what's going on.
So we also noticed that the parents also feel that, Hey, I need to get help soon. What should I do? I have no idea what to do.
So I think it's -- before we go any further, let's talk the current diagnosis of DSM on someone who we consider they have gender dysphoria. And this one, we don't look -- the DSM-5 recently, it's what psychologists, psychiatrists would use to make a diagnosis for a kid with gender dysphoria. So keep in mind, this one is just for children; this one is not for youth or adults, okay? So they have a different one.
So let's look at a category that they have.
So in order for someone to make the diagnosis.
the person need to have mild incongruence between his or her experience, expressed gender, assigned gender, lasted for at least six months duration, and manifests in six of the following.
The first one is, they need to have a strong desire to be other gender and insisting that they have the other gender. So they say, I'm not a boy: I'm a girl. Or I'm not a girl; I'm a boy.
And they also need to have a strong preference for cross-dressing or simulating the opposite gender. So they don't want to wear dresses; they don't want to wear boy clothes, that kind of thing.
They have to also present a strong preference of cross-gender roles. What that means is that they want to be like •- they will want to look like that. I want to be a boy. I want to be Daddy; I don't want to be Mommy, that kind of thing.
They need to have a strong preference for the toys and games and activity and stereotypical youth or engage in or by other gender. So that means they .. they like to play games, activities of the opposite gender.
And they also need to have a strong preference of play of the other gender. What that means is, like, the boys prefer to play with girls, and vice versa.
And then number six is, for boys, they need to have a strong rejection of typical masculine toys, games, and activities, and a strong avoidance of rough and tumble play. And in girls, they have a strong rejection of typical feminine toys, games, and activities.
And seven, and they need to have a strong dislike of their sexual anatomic things like, I don't have a breasts, I don't have a penis, I don't like my vagina, that kind of thing.
Number eight is a strong desire for the primary or secondary characteristics that match the gender that they identify with.
So for someone who met six of eight, then the kid will make the diagnosis of gender dysphoria. So I want to see a raise of hands here. How many of you have at least one of this -- meet those criteria? Let's see. Okay.
How many of you have growing up with two of those? How many of you met three of those? How many of you met five of those? How many of you met six of those?
So I think that's interesting, because, like -- and I think so, what that means is what we are doing here, is in order to make the diagnosis, is we look for signs for children.
But we look for sign that is not so much about gender identity. What are we looking for here?
We're looking for gender role and gender expressions.
So in this room, many of us have some sign of pathology here, more or less. You -- you ..
don't put make up on. You wear jeans. Check.
So you wear black, and you have shoes that is not high heels. Check. So all of a sudden, see what we are doing here? We are looking for .- the problem with this, we look at gender role and gender expression to make the diagnosis of someone who may be, or who is, a transgender kid.
But what we do here, is we can make a lot of mistakes along this road.
Why? Because that -- because, like, I can easily fit into this. And in fact, I fit all eight of them when I was a kid, but I'm not transgender; I just happen to be gay. Think about it. I mean, I don't want to have my penis cut off. But at that time, when I was young, I did want to look like a girl. I did admire to be a girl. I did feel like I would like to be a girl. I liked to play with girls. I liked to play with Barbie dolls. But that doesn't make me .- but I don't have that language, right? But I can easily say. Hey, it's a transgender that has the feelings that I feel. I can easily be misguide [sic] for that. Does that make sense?
So that makes sense.
So that is the flaw of the DSM-5. For the youth and adult, it's a lot better. Because what they are looking for, they're looking for the distress. They're looking for the distress between your affirmed gender, and your birth gender. How they con .• [indiscernible] between those two, how significant that is, how much that affect your mood, your .. your emotion, your mental health. That is much better way of doing it. But unfortunately, DSM-5 the most current one, we're still using this.
So what happened is DSM is assuming clear-cut differences in proper male and female gender dysphoria. So all of a sudden, a typical male (indiscerniblel young children becomes signs of pathology. And the gender vary can easily be interpreted as pathological. So we assume that boys and girls should wear different clothes, and a strong desire to wear clothes of the opposite gender are signs of pathology.
And play, all it says, what you like to play is even a sign of pathology. If you're a boy and you want to play with Barbie dolls, that is a sign of pathology, because you're supposed to play with them [sic]. Because according to DSM, that is one sign of pathology.
So therefore, you can imagine the number of boys referred to us for treatment in the early-on, it's like, nine boys to one girl, especially in the beginning.
Why is it the case? Anybody want to try?

why would that be the case? Yes.
AUDIENCE MEMBER: Because male roles were more tightly defined?
DR. WONG: Yes. Uh-huh. So you think about, like, when you have a kid, two, three, four years old, they want to dress as a boy, they want to dress as a girl, which is fine, which is cute, you know, laugh about it, doing it, take a picture, post it on Facebook and everything. But if tomorrow is kindergarten, tomorrow it i5. So all of a sudden, Little Johnny, we need to bury all your pink dresses, the fairy wings, the sparkly things. Tomorrow, you'll be a typical boy to go to school. And if the kid happy •• just happy to be who I am, or have pretty things, how will you think the kid will act on this? They will fight you tooth and nails, right? It's like, why do I need to do this? I'm comfortable to be who I am.
I just want to be who I am. But all of a sudden, we're introducing the ridged gender binary system on the kid, and the kid has to abide for them
[sic].
And very early on, they learn about the shame and guilt.
Something wrong about me.
Something really off about me, something that I shouldn't be doing in public, something that I should hide it and only do it in my room.
So -- and the funny thing is, when they get older, like in our program right now, then we get the reverse number. I would say more -- almost like, nine to one is girl to boys in the adolescents. And I think that will be something that we -- we - with some research, we found out is I think a lot of the time that girls ..
because boys, like you said, we would expect the ridged gender role and gender expression from them. But girls can be tomboy for a long time.
You can be a masculine girl, you can be an androgenous girl, you can be a strong girl for a long time. So until later on, they feel like, you know what? Just being a strong girl is more than I want. It's not enough for me. Then they let the parents know what's going on, they refer to us. So we tend to see, like, female to male referred to us a lot later than boys to girls.
So I think that the question doesn't always ask so who are the apples? Who are the orange, right? So imagine apples is the one who persists, go on to be transgender. And what about the orange? How many of them they desist?

And there's the new one is about both. Like, a fruit salad or something. So I like that •• that school. There's a well-known [indiscernible]
Einstein who come up with the fruit salad too.
So I think let's look at the early study here. So the early study here, they say, like, let's do a study. We may be randomly choosing, let's say 50 transgender kids. So we follow them. And then we, like, maybe when they turn adult, 19 years old, we want to know how many of them will persist to be continue to be a transgender kid. And how many of them will be desist [sic]. So those are early study that they did.
So what they do is -- so Green did a study, and said, You know what? Only 2 percent of them will continue on to be transgender. That means if you have 100 transgender kids in the sample, only 2 of them will be continue to be transgender. 98 of them will be gay or feminine male, masculine female, but they cisgender. And then Zucker and Bradley say. Hey.
it's 20 percent. 20 percent meaning that, Hey.
80 of them, they grow up, they grow out of it.
And then •- so similar. I think the most important number is 20 percent, because this is the one that always being used in code, in many places, in things like this.
So and there's time to watch a video. And see if we can get the video here. Good. So the sound is not that good, but let's do this.
[VIDEO PLAYING]
VIDEO: When my three-year-old son told me that he was actually a girl, I had no idea what to make of it. But then I thought, Okay, so he likes pink and pretty things, no problem. I can go with this. I figured the girl-thing must be a phase, but I was worried, and my child seemed so sad.
So I went to a psychologist. She said that I was right, it probably was a phase. She told me that
80 percent of kids like mine didn't end up being transgender. 80 percent, that's a lot. I told my family and friends not to worry.
But what about the other 20 percent? I didn't know anything about it. What was this transgender thing? I think I saw something about it once on Jerry Springer, That certainly didn't seem like a healthy option for my sweet child.
I went to conference about gender. And a doctor who works with transgender kids said something really interesting. She said that that
80 percent number was bunk. She said that statistic came in part from a study at a clinic for transgender kids in the Netherlands.
Apparently, when the kids stopped going to the clinic, the clinic assumed they weren't transgender anymore, but nobody checked up on them to make sure this was true. Maybe they found another doctor. Maybe their parents weren't okay with them being transgender. Maybe they moved. But we don't know, because nobody checked.
There have been some other studies in the United States. These studies happened in the
1950s up through the 1970s. They studied lots of boys who were considered too feminine for the time. The studies found that most of these boys grew up to be gay men and only a few them ended up being transgender. But they didn't distinguish between effeminate little boys and boys who actually said they were girls. What about those kids? What about the ones like mine, who insist they are another gender?
Today, there's a gender clinic in Toronto that works with transgender kids. Their goal has been to prevent kids from turning out to be transgender. This clinic claims that 80 percent of their patients get cured. And they have a long history of telling parents that kids like mine shouldn't be allowed to play with girl stuff.
Apparently, a lot of the problem is the mothers. So the mom's get lots of therapy too.
I tried a little bit of this method with my own kid. Her last Christmas as a boy was horrible.
After that, I stopped fighting my kid. I finally let her start living as the girl she'd been saying she was.
In 2013, a new study began at the University of Washington in Seattle. They're interviewing kids like mine, starting at age 3, and they're planning to interview them every year as they grow up to get some real research on these kids.
Unlike the older studies, all the kids in this study say they are a different gender. Will they still say this when they're older, or is it true that 80 percent of them will change their minds?
We're just going to have to wait and see.
So what about my child? Well, I actually already have a statistic for her. She's 100

percent amazing.
DR. WONG:
I love this video. It's just right to the point.
So easy, right, to digest what's going on.
Okay. So you can see, like, if .- and I think that is the reason, early days, that the professional people like myself .. and then they say, like, Hey, if only 20 percent growing up to be transgender, why should I help the kid's social transition? Why should I help the kid to learn about themselves, because chances are, they will grow out of it, right?
Think about it. I mean, if you go to the doctor saying that. Hey. I want to quit smoking.
I say, you know what, there's only 20 percent or
2 percent you'11 get lung cancer. Knock yourself out, right? So why bother? The odd is there.
And as a result, I think they are psychologist, or doctor, they think, You know what? We may be doing the parents a good deed. Just help the kids. Say. Your kid will grow out of it anyway.
Why bother to change? Because changing is difficult, changing back can be even more challenging. Let me save you a problem. Let me help your kid to un-tran [sic] your kid, right?
So that is how that happened.

But think about it this way, because this is DSM-5, and we are still doing this. So those studies during the '80s and '90s, so they're talking about DSM-4, DSM-3. So that same category is from DSM-3, 4, 5, and they're still using it.
So I want to do a study, and I want to know how many kids grow out [sic] to be transgender, I need to . first of all, I need to find transgender kid. I need to find transgender kid.
I need to make sure that transgender kid make the diagnosis here. So I need to look for a lot of sissy boys, or girls that they're tomboy, right?
So as a result, of course, I have 100 kids like this. How many of them would turn out to be transgender? Many of them just turn out to be like Dr. Wong, right? Very far [indiscernible].
So you can the flaw of this, because we need to have subject to do it. We need to have this diagnosis. So they make this diagnosis, but we, because we're using gender role and gender expression to make a diagnosis, all of a sudden, the sample is not what it's supposed to be. Does that make sense to everyone?
VARIOUS SPEAKERS: Yes.

DR. WONG: So gender varying children, I think it's very important for us to know it's a very heterogenous group in the gender identity continuum. So they may come in very rigidly saying to you, I'm a boy, I'm a girl, and this is exactly who I am.
Which is, I think, many of them, the feeling is genuine. But at the same time, we also understand gender is a spectrum. Your kids can be anywhere on the spectrum here. And there's little research and study done on the gender varying children and the way they may become as an adult.
So range from cisgender, LGBT, gender fluid, transgender, or anywhere along the gender identity. So as they get closer to puberty, like ..
or just random, put in 10 and 13. Of course boys and girls are a little bit different.
They tend to have more clear sense of their gender identity. Because why? Because they're exposed to different social environments. So they're testing out, they see different gender norms, gender -- gender -- people with different gender identity there.
And I think the second one is they're more mature. They know more about their sense of self. They're more aware of their body. They have the knowledge about - about what is going on, what is transgender, what is other things.
And then there is also more exposure to the media, to the people they happen [sic] on the LGBT group, and also to other people who are educating them about those things.
And then they -- also the next thing is physical change. If the kid, they indeed happen to be on the high-end of the spectrum of gender identity, they will say, like, I don't like my physical change. Why? Because I don't want to go through the puberty that I don't identify with. And then at the same time, they're emerging of their sexuality. So they can't [sic)
able to distinguish the way they know about what is sexual orientation, what is gender role, gender identity, versus what will be other sexuality issues.
So number five, they will come across more different sexual diverse individual. And I think that is very, very important too. Because when they -- like I mentioned earlier, because the kid, they only see two. And so in our -- in our play group that we have, all the kids, they are all along the spectrum. And then they come to the play group. We don't encourage them to one gender ID or the other, but we do play and add therapy together, help them to learn about themselves. So they happily build a
[indiscernible]. But the thing about it, is they see other kids, Hmm, how come little Johnny see themselves as a girl, but can present in very masculine way? How come little -- little Mary see herself as a boy, but little Mary can be in a way that don't quite match as boy? I think that is good for the kids to learn, how other kids along the continuum may look like. Because then, all of a sudden, they learn about, Hey, gender is more than black and white. Gender is indeed a continuum.
So -- and then in -- because kids are so young, we don't give them any medical intervention at that point, but we -- there are things that we can do to help the kids to be able to feel -- to -- to work through these feelings.
So we -- the five here says the first thing is validating. I think it's very important for parents, for schools, for grandparents, for relatives, friends, validating their feelings, you know? Their feelings is genuine. How they feel is really how they feel. And they may not be what they interpret. An interpretation of the feeling may not be what it is, but we need to let them know, Hey, how you feel is important, and I respect your feelings.
Next one is support. I think the support --
we need to able to provide support, allow them to, like •- able to, like, explore, give them support and create opportunity for them to. like, Tearn about themselves, give them information that they need. In this way, then the kid will feel safe to learn more about who am I and what am I?
So advocating. A lot of the times that you may have to •- if the kid feels so dysphoric to a point that I need to -- I cannot just live a double life. I need to live a boy or girl outside of my home, then you may need to advocate. Hey, let's see how we can do this at school in a safe way. How can I advocate for you, people will respect you. How can I advocate for you if bullying happens or harassment happens?

And then education. I think that for kids, we have a lot of children books here, and the video, and also conversation with the kid.
Communicating with them is very important.
And the last one is accommodating. And this will be the one that I really want to focus on more, and what we do accommodating.
So -- okay.
So accommodating, more or less.
that we're talking about a social transition.
Because that is that - we have found this very successful to help the kid to learn about who they are, to feel comfortable about who they are.
and to be who they are.
So since gender varying kids are too young to consider any medical transition and outcome can be different, so social transition is a very good option to accommodating that. So social transition, meaning a change in social gender role. It may include all of the above, or some of them: Change of clothing; names; appearance:
and pronouns. And I think many of you that you have some -- come across some kid who are transgender, you will see, like, the clothing is a big thing for them because they want to pass well. And then the name, they will likely try different names -- oh, that's a funny thing too -- and they will pick a name that fit the affirmed gender. And sometimes, because now, if they have a chance to choose their name, they may choose the most wacko name you can think of. And it's likely they change it 20 times.
So I have a kid, and it's a boy to girl, and she would like to try out all the princess ..
Disney princess names. And you can imagine, every two weeks, I'm Jasmine to Mulan to .. and so on. So I think the parent, you can set some limit. I mean, supporting your kid doesn't mean you don't set limit. You can, like •- let's just drop down to, like, five or six names, and we '11
try in a significant period of time, rather than just, like, two weeks, you know? And I think they can get, like, Oh, that doesn't feel right when people call me that. And I think it's important for them to have choices, but .. but let's have some limit. Doesn't mean that you just let them take the ball and run.
And then appearance. So many of them, they would like to pass well in the gender that they identify with. So the girls, they may cut their hair shorter, they want to wear blue jeans.

And then the pronouns. The pronouns, for young kid, they're still quite binary. So if I see myself like a girl, just use female to describe me until they get older. If they are somewhere on the continuum, they may use different pronoun to describe them.
So I think there's one video I wanted to show is this [sic]. So we always talk about. Hey when kids this way, because •• before we accommodate with the kid, I'm up here, they want to know, okay, so maybe I am the bad parents who make this happen. When I allow my kid to social transition, my relatives, my in-laws, or other friends, they challenge me, that I'm too liberal.
I'm doing something that will damage my kids.
So half the time, they feel torn in doing this or not. So I think that -- I think -- we always talk about nature and nurture. I think this will be a good video to talk about.
[VIDEO PLAYING]
VOICE ONE: With the wonderful Laverne Cox rising to fame, Bruce Jenner's groundbreaking interview, transgender issues are finally making it mainstream.
VOICE TWO: So naturally, we're going to science this up.

VOICE ONE: Hi, everyone. Julia and Julian here from Day News. Transgender means a person identifies as a gender other than what they were assigned at birth.
VOICE TWO: Cisgender, on the other hand, are those who identify as the same gender they were assigned at birth. Unfortunately, being trans is a much more difficult path than being Cis.
VOICE ONE: Transgender individuals face a world filled with violence, erasure, and ignorance. But by being true to themselves, they open up a road for so many others of follow. Still, why would anyone purposefully subject themselves to a life of difficulty? Well, it's not a choice, it's who they are, and science can back that up.
VOICE TWO: One study published in the Journal of Neuroscience, identified networks in the brain associated with gender. Using diffusion-based magnetic resonance tomography imaging, the researchers looked at the brains of people who are transgender, as well as female and male controls.
VOICE ONE: They found microstructures or connections in the brain that differed significantly between the male and female subjects. However, the networks in the brains of those who identified as transgender seemed to take up a middle position.
VOICE TWO: The researchers also found a link between these networks and the amount of testosterone in the bloodstream, suggesting that sex hormones affect how these structures form in the brain, which is supported by earlier research.
VOICE ONE: Right. Some regions of the brain show a difference based on gender. In one study published in the Journal of Psychiatric Research, scientists used MRI techniques to scan the brains of 18 people who were assigned female. but identify as male, and 24 male and 19 female heterosexual controls.
The researchers found that the white matter of female to male individuals who received no hormone therapy, more closely resembled the brains of the male subjects than the female subjects.
VOICE TWO: Another study by that same research group, also published in the Journal of Psychiatric Research, focused on those who were assigned male at birth.
but identified female. The researchers used similar techniques as the other study, and found that their white matter microstructures fell between the measurements of male and female subjects. One of the authors of the study concluded, Their brains are not completely masculinized and not completely feminized, but they still feel female.
VOICE ONE: And if it's a matter of brain wiring, a lot of kids would know early, and they do. In one study published in the Graduate Journal of Social Science, found that 76 percent of participants knew they were transgender before they left elementary school.
VOICE TWO: A small study published in the Journal of Psychological Science found that kids as young as five, who identify as trans, showed a consistence in gender identity across various measures. I actually saw Laverne Cox speak at an event at Rutgers, and she said exactly the same thing.
The researches asked 32 transgender kids, age 5
to 12, questions about gender, and under the implicit association test, to see how kids identify with various things.
Using the IAT, the researchers could see how quickly the kids associated gender with the concepts of "me" and "not me". It's a fast test, so they don't have a lot of time to think about it. they just respond.
VOICE ONE: The researchers found that the kids' responses were indistinguishable from their cisgendered peers. The transgender girls responded the same as the cisgender girls, and the transgender boys responded just like the cisgender boys. The researchers concluded that their study provided clear evidence to support that transgender children are not confused, delayed, pretending or oppositional. They instead share responses entirely typical and expected for children with their gender identity.
VOICE TWO: We know that gender is a complex and varied issue, even Facebook recognized that reality. To learn more about that, check out this video right here.
VOICE ONE: So in addition to --
DR. WONG: So I think that's very interesting. I think that some of the science telling us that, like, how the brain really affects how they know about themselves. And I think that's very true. When we do a mental assessment, a lot of the time the kid will say, like, I just know it. My brain just telling me that I'm not a boy. I'm a girl.
but somehow my body is the other way. And that is very interesting. That's exactly how -- how the brain is different than the body is .. appear to be.
So .- and I think while we're talking about social transition, I think that it's important not every kid need to be just, go out to public and say Viola, I'm a boy, I'm a girl. And I think that is .. there is some symptomatic way that we can do, depends on where you are, the family comfort level, and the support level that you can get.
So a lot of time, we really encourage the family too, if they are really knew to this, maybe they can start from the micro area, and gradually expand into the macro area. So maybe you can try social transition part-time within the family. So some of the example is some of the parents, they will do, Hey, why don't you, like, every night, since you would like to be a girl, dinner time, you can be Cinderella. You can dress up as a girl, we can call you Cinderella. You can be a girl. And then we see how comfortable you feel.
If the kid says, You know what, I'm old enough to be Cinderella, and I want to be Cinderella passed 12:00 o'clock. I would like to do it full-time. So then Cinderella, so with the parents, say. Okay, now we can be able to have you do it in the family full-time, then you can be Cinderella.
So after a while, let's assume Cinderella said that, Hey, full-time is good, but I want to be .- the whole village to know that 1 am Cinderella. Then we can talk about, Okay, how we can expand the social transition gradually to the next one, and how we can develop a safety plan and support for this kid, such as in school, in family gathering, or church, or shopping mall, things like that.
So social transition began within the micro system, and you can gradually expand into the macro system. It really depends where's the development stage, where they are, the support that you are, and where you are. Because, like, I think doing social transition in Vancouver is relatively easy, versus you live in Quesnel, or Prince George, right, or some really remote area, everybody knows your past, right? So it doesn't matter what school you change, people still know that you were once little Johnny, right? So it's really different; then more challenges that we have.
And the condition may require you to take on an active role to how initiate and facilitate the social transition, especially if it's going to expand to the school setting. What we do, if the kid is transferring from the family system to the school system, a lot of the time we will go to the school and talk to the school principal, the teacher, and the school counsellor. Then we sit down and have a school meeting. We talk about how do we develop a safety plan for this kid.
What if bullying happened, what can we do?
What if the kid -- because sometimes, the kid isn't being -- they don't want to be mean, but they are curious. They will ask the funny questions, Hey, Johnny, are you a girl or a boy?
So how will the teacher deal with this. right?
Just question like this.
What about other parents if they complain?
How will the school deal with this? So those are the meeting that we go to and help them to develop some safety plan and back up plans, so that the school feels like they have some tools for this.

The child may want to begin the social transition full-time right away. And then if that's the case, then we help them to develop the risks and benefits of doing it. We also develop the safety so that we now have a development plan to support the kid. And the child may want to switch back and forth from full-time social transition to part-time, and based on their comfort level and life circumstances.
And I think this one is very, very important for all of us to remember here. The kid .. if --
I'm really saying that gender is a spectrum here.
So if I identify this way, I go to it this way: I go all the way here. And then I say, You know what? That is way too feminine. I need to tone it down a little bit, right? So the kid will do that. And I think the parent will need to be sensitive to that, and give them room to do it without questioning them, right?
So what we do with some of the parents, if it's -- like, for example, one parent is like, Do you have a female • a male to female? So they want to be a female. So they, at that time, the girl want to have make up, dresses, and all those things and put it on all the time. After, a year later, and oh, you see, this girl is wearing sweatpants. So the parents think, If you want to be a girl so bad, why do you want to wear sweat pants all the time?
What's wrong with this message? Very wrong now, because you're in this class, right? But when you're not here, you would make that mistake too. Because sometimes we -- it's just how we think, right? So I just tell the parent, No, no, because who on earth would put on makeup, look like Barbie doll to go to school all the time?
It's tiring. Nobody want to do that. And you shouldn't be enforcing the extreme gender role onto your kid. But they think this way. If you're girl, you want to be a girl so bad, why ..
you need to be that, right? And the kid, they will do that in the beginning, because why?
Because they try to convince us that they're truly a boy, truly a girl.
So they, what society, what a girl is supposed to be, they will have everything put on them to look like a girl. What a boy supposed to be, they will have everything that make them look like a boy. But then later on, they realize they will take off some of the things that doesn't fit, right? And that is the thing that we need to see. That doesn't mean that they are not transgender anything, that means they are adjusting and modifying where they are on the continuum.
So •- and also unpleasant experience such as bullying, harassment, sometimes can make the kids regress, and at times, stop the social transition altogether. And we have this happen in the past.
So I think we need to be mindful about that too.
So social transitions should be done jointly with the kid and the parents, and also with professional together, and also extended families together. And I think the key is help them to lead, and follow. What that means, is we don't have to get too far ahead of the kid. That means we don't have to tell the kids, like, Oh, you're transgender. Well. Mommy will make sure that you will be able to live as a girl. I will make sure at what age you will have blocker. I will make sure that you will hormone at one age. I will make sure that you will have surgery. So let's not get ahead of them. I think help them to lead. Because if it's not enough, not comfortable in their skin, they will let us know one way or the other, they will. Through their emotional, through behaviour, they will let us know.
I think the key is seeing where they are.
and then we'll just accommodate them. So we place close attention to what they communicate with us about their needs, and observe any signs of distress. And then we can modify the plan.
Think ahead about what they may need in the next development stage, because new • in the new development stage, they will have a new set of challenges. For example, like, they are able to go to school as little Mary, which is good, but at some point, I want to have a sleep over.
right? How would we navigate that? At some point. I want to go to summer camp as a girl with all other girls. So how do we navigate that?
So when they get older, they will have new challenges and new development needs. So that social transitional plan need to be modified to meet their developmental needs, regardless if they're boys and girls or transgender kids. So we modify those five keys, and then should be the regular basis on developmental -- development stages.

So of course we always discuss the pros and cons in terms of the social transition so that they will be able to make the best decision on that. And then we would like to communicate regularly and clearly with the kid, and the family, and the support system, so that the kid has the freedom to reverse back at any time.
Remember, the adjustment, right, it's very important. Of course, we need more research on this.
So what we see the advantage of doing social transition, is when you allow the kid to explore their -- the desired gender, a gender role or gender identity, they do better. Their emotion get better. They tend to be less depressed, less anxious. They have less mental health symptoms, and be able to have social interaction with their peers. And I think that is very important.
when -- many of the kids, they will not want to play with the peers that they want to play with, because they feel like I'm out of ..
because when you're five, six years old, the other five, six years old kid, they're gender
[indiscernible]. They will say. You are not a boy, go back to play with the girl. I don't want to play with you, right? So very fast they tell you this.
So I think the social transition allow them to live as a boy or as a girl. They are able to play with the peers that they want to play with.
Be able to take on the activity that they want without fear of being ostracized. So again, so sometimes, like, I remember this when I was a kid, that I would like to play with girls, play Barbie dolls together. So for the transgender kid, if they're like, Hey, I see myself as a girl, and be able to pass well as a girl, then all of a sudden. I can play with other kids.
The point is not so much about my kid is a boy or a girl. I think the kid is -- my kid can be able to have the same opportunity to meet his or her developmental needs. My kid be able to be a happy and successful kid. My kid be able to go through school and make friends. And that is what we want for our kids, regardless the kid is a boy or girl or transgender kids.
So -- and then we also found out that the kid is easy to blend in, so they feel more confident, they feel more outgoing, more positive family relationship comes into action. And I think that's very true, because all of sudden, you don't have the fighting over what clothes to wear. You don't have the fighting about the pronouns anymore. Because at that time, when their early on, your relationship with the kid is building positive attachment. If you're just fighting over things like this, it's not the way to build a positive attachment.
So I think that we need to know, Hey, what you want to wear, we can accommodate that.
What's more important, is how we can build positive relationship.
So -- and then there's a lesser chance of bullying. Why that's the case? Because they pass well. When you're a young kid, you look ..
once I cut my hair short from a girl. I look like a boy, right, and everybody complain. Can vice versa. if a boy grow the hair long, very easy to pass as a girl, because at that time, all the kids look asexual at that point.
So we also lessen the stress, have a chance to attend other development tasks. They feel safe when they can go to school. They feel safe to go to a volleyball game. They feel safe to go to the pool to go swimming, different things.

More likely to attend school, which is very true.
So -- and working with the gender varying kids, we really encourage to have a wrap-around approach. So we encourage to have a team to support the kid, like, maybe including a psychiatrist, psychologist, mental health therapist, family therapist, pediatrician.
endocrinologist, social workers, parents, extended family, school staff, and even church members, sometimes. If they have -- or your own ethnic elders.
So -- and I think I will pass the time to my resident, talking about a surface model that we do, and why we think this is the best practice and the way to help our kids. So I pass it to Maronique [phonetic] for a couple minutes.
RESIDENT: Jump in if you --
DR. WONG: Yeah, jump in.
RESIDENT: -- if you have anything.
Hi, I'm Maronique, I'm currently working with Dr. Wong. This is very -- a really great opportunity to get into this field and learn and hopefully support more transgender children in ..
in -- through this process. At the Gender Health Clinic right now, we use a two-tier model. So --

which incorporates a clinician after -- within the first tier where they +- and they -- with the -- in tier two, we -- involves the specialists, so the assessments and everything.
as well as other professionals involved, like ..
and -- organizations such as hospitals, schools, and interventions.
So in the first tier, where we involve more of the - - more of the - so in the first tier, the youth or the child will work with the clinician, where they focus more on exploration, education, answering any questions where they have the opportunity to explore, and the process.
So any questions on -- that's where they get answered.
So we want to make sure that what they're experiencing is true, if it's -- rule out any mental health concerns, whether what they're processing is due to mental health, or any other factors that are not related to them, the transgender piece. So we want to have a clinician involved at that level to kind of act as the first level or support.
So it's -- and an important piece of that is -- that we talked about, is exploration, challenging, making sure that what they're experiencing, thinking is true, is not because of any transphobia or anything involved like that.
Reality checks addressing impact •• so a lot of times what -- experience of just conversations with these youth and the children, is a lot of mental health distress, the bullying. So those are opportunities to address some of those challenges as well with the clinician. As well as providing opportunities for people around who work with the child: The parents; the school teams; providing supports, which Dr. Wong talked about; and family counselling might be needed.
Helping them prepare for the -- any assessments that they go through in the tier two process, like the hormone readiness, any surgery readiness, the diagnosis, dealing with any crisis interventions if they might express any suicidal thoughts, and that kind of thing.
So in this tier two level, this is where .-
what we do in the clinic, is we do a lot of assessments, which is very comprehensive. We see the child or youth through several sessions through looking and ruling out any mental health concerns, ruling -- looking at their self that's .- we try to follow best practices, which is . also aligns with what they're doing in Australia and the standards best practices that is presented in the field.
So we separate -- the assessors try to separate themselves from the clinician role so they can see the child in a more objective way, So by providing convergent evidence to, yes, multiple layers are -- are confirming that, what the child is truly experiencing.
So in the tier two level, the assessors hold the responsibilities and liabilities, and that's why we want to make sure everything is done in those multi-disciplinary level --
multi-disciplinary ways. We also provide the recommendations of the assessments following the assess -- the assessment completed, and we have meetings to share the results with the youth or child and the parents, as well as any other people who might want - - they might want to be involved, like the schools and professionals.
DR. WONG: Thank you. So that •- that model that we're using is in the Ministry. So that, the program that's starting in 2011, like I said. So now, we have about more than 500 kids in the program working on it. So that - that program is good. If you Tive in the area, that is Surrey, Langley, or Delta, so your •- your kid can enroll in that program. If you live in Vancouver, unfortunately, we need to let Coastal Health know that they need a program like this.
So -- but nevertheless, I think that our work is not -- our child is not -- the parents are in a lot of anguish when they come to family work. They're talking about like, My •- they say, Oh, my child is not really transgender.
They may say that's just a sign of mental health.
They're just confused. They learn from the trans peers. That happens quite a bit the parents claim that. Or it's the internet's fault because they go on the internet all the time, that's why they become transgender.
So I think .- I -- the assessment will of course look into that, but I think that what I see is a lot of time, the kid, they go on the internet a lot, is because they want to find out what my feeling is out there [sic]? Who has similar feelings as I do? And they feel ostracized, right, by their peers. They want to find friends with similar feelings who can support them. More than because I find out there's a transgender kid and you make me trans.
And there's no research supporting that at all.
And so I think that's something we need to keep in mind. And the parents may be. like.
embracing transgender identity will lead to harassment and physical harm. And so they're really worried about their kid will be bullied or mistreated. And I think that's the reason why they work with professional together. Have an advocate with the school, with the other system so that their kid will be protected.
So -- Our child will have an unhappy future, that my child have no job. no friends, and no love relationship. And I think this is also is not true. Not with the 1,000 kids that I see.
Many of them, they find love. Many of them, they find happiness. Many of them, they find job.
And so our society in Canada or in Vancouver is a lot different than other society. But definitely, many of them, they grow up to be independent, and just as a productive citizen as other people.
This is happening way too fast. So what they mean is, like, She just came out to us, and they want everything. And I think that's kind of good to find professional help. How we can help this kid. What is needed. What we can wait for later. What is not needed.
So what we do wrong? And I think that is very maybe parent [indiscernible]. I mean, when I .- not so much in this year, but a couple years ago, every time when I tell the parents after the report is, You know, very likely your kid happen to be authentically transgender kid. And this is what we can do, and many parent, they just start to cry. And I can see the worry, the concern that they have, because the love that they have for their kids. And they all say, Oh, maybe I do something wrong.
Maybe because I was taking anti-depressant when I was pregnant with him, or of maybe this. And I think there is .- they blame, and overwhelming the parents, the loss.
and the grief that they have is quite important to address.
And I • on top of this, I think that sometimes they -- the kid. they may not see that.
They •- a lot of times, I would tell the kid is Tike, Your mom and dad is not fully onboard.
It's not because they don't support you, because they're just knew on this. They're still going through the grief and the loss. You take you three years to learn who you are; your mom just learned last Tuesday when you came out, right?
You need to give your mom some time to learn about this. And then what your mom learn through the TV, is that all the transgender people have a negative ending.
Of course they worry about you, right?
So -- and -- so they think •- some parents say. Oh, this is very embarrassing. How am I going to explain this to the family? And I don't want people to think, What kind of parent would say this? And -- and I don't want to undermine the difficulty they go through. Some parents, they really feel this, especially for ethnic minority group, because so tightly connected.
Like, I mean, it's like for immigrant, myself, you know? So when -- I remember when I go on TV and talking about transgender thing, and I'm talking proud. When I go back to Richmond, the dim sum lady [indiscernible] You pro trans.
Shame on you.
I go -- my mom go to the butcher, the butcher is like, Your son on TV. Oh, I can't believe your son support those sickened things.
So think about it. It's so tight -• I'm not saying right or wrong, but when it's so tightly connected, it's very difficult for the parents.
It's not -- I'm not even grieving about losing my kid become a boy or girl. I . if I support you, I have to abandon my entire community. And that is not easy. Imagine the loss. Imagine that you support your kid, you have to move to Korea.
Think about that. How are you going to live, right? Who is going to understand you? who is going to see a doctor who will speak your language and be able to treat you, right? So I think we need to think about that.
It's so easy to judge. But what they go through, and the complexity of our society, we need to be more empathic and understanding. What would the neighbour . other thing, this is the loss of us.
So again, I think parent would go through a significant loss and grief. And they may go through, like, Our child is too young. She'11
regret this later when she's older. They're worried the child is just being impulsive and it's a phase. And I think if we have doubt like this, let's have an assessment done. Let's talk to professional about it. If you don't think this one is really able to address your concern, find another specialist to do it. Get a second opinion.
So this is our numbers. Any questions that you have, feel free to call. That's our clinic.
And we leave some time for anybody to have questions for us. And again, we appreciate the opportunity to talk about this. It's a topic that everybody is thinking about, right? Okay.
Thank you.
Okay. Questions. Yes?
So the assessment that you showed us for young children is very much about the binary; are you male, are you female? But if some -- do younger children talk about non-binary, or is that something that something that [indiscernible].
Not s0 -- based on the age. Based on the age. 1
think more sophisticated, more mature they are.
they will talk about it. I don't see ..
sometimes they will say, I feel sometimes a boy.
sometimes a girl. They may not have the vocabulary to say I'm a demi-boy, I'm a demi-girl. They may not have that. But they will say, Hey, sometimes I feel like a boy, Or I feel like a boy, but I still want to keep my vagina. Something like that, they will say that.
I think the assessment is not so much about binary. With assessment, we try to rule out.
because when a kid come to us, we want to know the feelings that they have, what are the contributing factors? We want to know what contributing factors are affecting the kids'
interpretation of their gender identity. So we want to look into -- it may be due to mental health, may be due to the kid confusion of the gender role, gender expression, or gender identity. Maybe the kids have some confusion with the sexual orientation identity, may be due to the kids have body image, may be due to trauma. So we rule out one factor at a time, because there's no test or blood test to say, You are transgender, right? There's no test like that. But we can go the other way. We can look in different factor. Do they play a significant factor? If they're all negative, negative, negative, negative, then I'm confident to say, Hey, I look into everything. There's nothing explaining. So I'm more confident to say, Your kid likely to be authentically a transgender kid.
So that's how we go about doing the assessment, instead of just, like, are you a boy or a girl?
Okay. Yes?
@ How do you sort of temper the child's expectations? Because sort of the example you gave earlier was, say for example, you have a boy who wants to transition to a girl. and he expects to like a Victoria's Secret model afterwards. 1
mean, I'd love to look like a GQ model, but it isn't going to happen.
So the question I have, is that when the kids do the internet research and look up everything, they sort of -- they're smart, but they don't have wisdom.
A Yes.
Q They know -- they know what it is they need to do in order to get where they want to go, and they have the expectation at the end, I'm going to look like this beautiful -- but how do you sort of bring them back to earth and --
A In a more realistic way.
Q -- everything that you transition completely.
you're not going to look like the Victoria's Secret model if you're starting at five years old.
A And I think that's where the tier one comes in.
Because I think that they - even though we finished assessment, that you happen to be a transgender kid, but we still would like - - some of the time, they need some support on this.
Because we need to, like, kind of gear you about what would be a realistic expectation. Are there any unrealistic, over-idolizing? And that would be a good place in session with a counsellor talking about this. Because a lot of times, some of the times, the kid is like, All you need is put me on hormone, then I will be a boy or a girl. Voila, 1 am. Which is not true, because there is a process. We don't give you full dose hormone right away. We give you small doses and see how you're doing, and gradually increasing it. So that means it's a journey. There's a process for you to be who you are, right?
So how are you going to deal with in between? It's a journey. So I think that they need to -- we need to have a support for them to support the social/emotional adjustment while they're going through the social transition or medical transition. So that they know, Hey, what if I -- let's assume I'm on hormone, I start growing a beard, but I still have a D cup breast, right? They don't think about that. They think, I'm on hormone. I have beard. I look like a dude. 1'11 be good. But no, there's -- it doesn't go away overnight. I'm wishing I could do that, but no.
How are we going to have beauty adjusted to feel comfortable, to still go to school, to have friends. And that is where the tier one comes in. Does that make sense? Thanks.
Any other •- yes?
What would you say when sexual education would be as provided, you know? Would you feel that that would be independent of a parent, for example, I guess, like in a school setting? Would that be more effective?
I don't think there's one way to do it, because I think every family is a bit different. And I think definitely. I highly encourage the parent to have an active role during that. But having said that, there are things that kids, they don't like talking to parents about those things. So that's the point, I think, is also having maybe someone they feel comfortable talking with. So Q
A that can be a sex educator, or it can be a counsellor, it can be - it can be even a priest.
or • depends what they feel comfortable with.
So I think don't rely on one source. And I think more multiple level, I think that's good.
But having said that, regardless what that is, I prefer the parent to take an active role in this process.
So with the assessor •- assessor part and the clinician part, does some of that take place at the same time, or is it sort of a different time Tine or, how does that work?
It really depends. Because, like, in our program, a lot time, once they come to the program, we assign them a clinician, right away.
Sometimes they don't really have anything going on. They're just like, Just give me hormone.
Give me something. I will be fine. Which is great, but sometimes, some of them, they would like us to give them some education, give them some help. So it can be happen simultaneously.
it can be happen one after the other, or kind of like this. So it really depends the individual, the family, where the kid is. And that will be the key. So we don't really have one set of how that happens. We don't have a sequence or A, B, C, D. It's really dependant on the individual.
But I think that would be the best approach because that's a more individualized approach with flexibility based on the family and the individual needs.
Yes?
Q So not necessarily a clinician, is what you're saying?
A No, not necessarily. It can be a school counsellor doing the tier one work. And then the school counsellor. Hey, I did all this already.
I think this kid need to have an assessment done.
And they refer to us. Then we do the tier two work. And then we work with the school counsellor together and let them know what's going on, how you can continue to support the kid. Definitely.
Yes?
So I was wondering, on the DSM information, it's stated that there should be a period of at least six months for the child to --
A M' mm-hmm.
Q
•- [indiscernible] gender dysphoria. So I was wondering what are your thoughts about should there be, like, certain period of time between the moment that the child first says, I'm not a boy, I'm a girl, and until the social transition?
Because as you said, like, there are benefits and drawbacks for the social transition process.
A So I'll see if I understand you correctly. So when the kid start making those statements, should I wait for six months and do something about it?
Yeah, how long until your first start A I think that -- depends on my role. If I'm a parent, and the kid said. You know what, I want to try, like, a Pinterest, I say, Okay, let's get you Pinterest. Just make sure that you're safe, that you will be in a place that I can support you.
So I wouldn't wait to six months, because like, because you need -- the thing is, it's the subtle message that you're telling the kid. If the kid telling me we want to wear pretty things.
I say, you know what? Let's wait six month if that's real, right? What is the message I'm telling the kid? Something is really wrong with your desire, right?
So what we want is to support our kid. Say.

Okay, if you want to do it, let's try it out.
But of course, we need to think about safety.
right? So let's think about how we can try it out to support you in a safe way.
• So what happens if my child says, Oh. I want to go, because you've spoken about it before, that the child wants [indiscernible] everything --
A Yeah. And I think that I would set limit with the kid, how can we do it in a sequential way?
If the kid's parents say. I feel kind of lost along the way, then find a specialist to come in.
Hey, how do we lay this out for the kid? And a lot of time, the kid, they really want to be there, the gender they see in their mind. And if they know there's a road map to help them to get there, they're willing to try it, I think. So having someone to help them develop the road map is important.
Yes?
I appreciate that a lot of study still needs to happen, but I wonder if. with the children that you've seen, that you work with, if you've noticed any correlation at all between expressions of gender versus expressions of sexuality?

A M'mm-hmm.
In our instance, you know, we have a child that is decidedly moving from one place on the gender spectrum to another, but I'm wondering what to expect, if anything, in terms of expressions of sexuality that go along with it. I'm not 100
percent sure if my child has decided where they want to go in terms of .. I'm not sure that they're actually reaching out to other people to express, you know, emotions of sexuality and attraction, anything like that.
Has it been your experience that transgender children kind of withdraw in terms of seeking out sexuality, affection, that kind of thing, or...
A I think I understand part of it. I try to answer and see if I get it right, if not you can ..
Q I'm struggling to get the question.
A Okay. So -- no. No. So you have something to add on? Okay. Okay. So I think that we think gender is a spectrum. I think that sometimes the kid, they really like to try things out, moving around quite a bit, and I think that is important. Having said that, I think there is --
in the younger kids, there they are -- sometimes, they will be like .- since I like pretty things, that's more sexual general role, gender expression, but, Oh, I must be a girl. There are some kids, they feel this way.
And so that is through the assessment. It's like, You know what? Let's try you -- get you all the pretty things first before we do anything about it, right?
So I think that having a professional, you know, and some specialist to go look into it and kind of dissect it, what are we talking about here? Because what they present to us is lump sum of things, all mixed together. Who I like.
what I want to dress, who 1 am, all those sexuality things mixed together. How are we teasing out what is what? And then we can. Okay.
what are we dealing with here? I think that will be, based on what -- my interpretation of ..
that's what I would have done.
Okay. Yes. Any other -- yes?
Q You mentioned that your quadrant was specific to the Delta, Surrey region?
A And Langley.
Q And Langley, Where would you direct people that are in Vancouver? What direction would they take?

A 0h, [indiscernible]?
Q None?
A You just have to find someone privately to do it.
• Окау.
A And that is where you need to advocate to the government. That is where -- even the Ministry right now that we are doing this, and we just doing it in a way volunteer doing it. Since we volunteer doing it, they have us volunteer for, like, eight years doing it. And so the cases kept piling up and up and up, and Oh,
[indiscernible].
So I think that the government, if we don't advocate for this, it will never happen, right?
So why would I give you funding when there's no need for it? Why don't I just give it to somebody else for something else, right? I think that as a community, if we think this is what you need, go talk to your politician in your area.
It's that, You know what? That is, yes, how come my kid need this and I don't have support for this? How come I have to go all the way to Langley to a children group for transgender children group? And why -- I should have something here. How come I don't have it, right?

I think -- I think in a way, that is up to us as advocates, otherwise, it will never happen.
Yes?
Q If you live in Surrey, how do we get involved in the program?
If you live in Surrey, that is another thing. So if you live in Surrey, definitely you will need to open a file with [indiscernible] Mental Health in your local office. And then your kid, as long as is younger than 19, then your kid be able to refer to our program.
• Окау.
A But having said that, because, again, the limit of money and funding. So they try to, like, if your kid is sick enough, they will, like. No.
we're not taking it.
So I don't know how to say it, but I'd say it in a way that you let them know how urgent, how important that is. Otherwise, they just --
Q And what is the name of the program? What is it?
A The Gender Health Program.
@ Gender Health, okay.
A Yeah, Gender Health Program. You should say, I talked to Dr. Wong. I live in that area --
Q Yeah.

A •• I would like to be referred to him, he keep saying this, right? But in a way, I really think -- I truly believe in preventive care.
Because, like, I think what the government --
okay. Okay. Don't tape me on this one, I really think the government is doing reactive care.
VARIOUS SPEAKERS: Yeah. M'mm-hmm.
DR. WONG: What they do is, like, We are so short of that.
We'll wait till your kid is sick enough, suicidal, running away, cutting, then we take you.
VARIOUS SPEAKERS: Yeah. Yeah.
DR. WONG: I mean, so and this way -- I -- I remember the first time I went to the transgender kid .. the meeting for a transgender kid. There was like 20
professional sitting there from the hospital to the community, school, everybody, because this kid is suicidal. Nobody know what to do at that time. But if we can give this kid early on preventive care, give them what they need, know what risk level they will work themselves into, we can prevent a lot. We can ..
Because in a way, we're teaching the kid.
You need to be sick enough, then we will give you what you need. So what you need is, you know what? Pull a stunt. Suicide, every time, they will give you what you need. They learn that.
They learn it very fast, right? If I want and need this. I just need to, Hey, Mom, right?
So I think that even the government is.
like, telling the kids, Hey, wait till you're sick enough. Don't do -- we do reactive care here. We don't do preventive care.
Yes?
So kind of following on from that, did you say you had 1.000 patients in all. And what area are you drawing from? Is that just Richmond --
A The 501 is from the Surrey, Langley, Delta.
A The other 500 is my practice.
Q And so is that all across the province?
A All across the province. Some of them across different provinces, and different countries too.
Yeah.
Q Okay. So I guess what I'm really asking is, is what -- what's your guess as to the percentage or the number of folks in 1,000 ••
A They talk about like, 1 in .. like, 1 in 10,000.
But now, the way it comes, we think it's a lot more. And I think that back then, they do that statistic, is they say, Okay -- because the reason, the only way you can track it is when you come see me, then I can report to the health authority, right? But if you don't see me, if you live so far away, you are not being counted.
If you -- like, some of the transgender kid, in youth, they kill themselves; you are not being counted. And you're so closeted, going in the closet, you're not being counted. So that number is not really accurate, but it's about 1 to
10.000 at this time.
Q But that's not your guess.
A No. No.
@ Your guess would be 1 in 1,000?
A I don't know. I would say •- I don't know. It's a lot more. But 1 *• But I think the 80 percent number. like, 80 percent they grow out of it, if that is right. I'm so blessed that I'm seeing all the 20 percent. I am just so lucky. Just so lucky. So that, I can answer you, now.
Yes?
Q And what about young adults who are just sort of coming out? What's ...
A Well, young adult is a different development stage, definitely. So they have .- they're more mature, they have -- regular individual I'm talking about. And then they will be, kind of like, knowing the risk and benefit. They can consent themselves.
So a lot of the time, the treatment is really depends on any significant issues that we mention in the tier one here. If they don't have that, then the way they move forward will be a lot faster than the younger kids or adolescences, right? Because they're adults, they are - the doctor will assume they know the risk and benefit. You work with any of these issues presented. And they will work through to get what they want, to be the way that make them feel gender confident. So it can be, like, medical treatment. Can be hormone. Can be a combination of medical treatment and counselling. It really depends. But normally, the process will be faster than a younger youth and children.
Yes?
Q Hi. I'm a sexual health educator who works predominantly with folks who are [indiscernible].
And so I know that the research is showing that there's an occurrence of autism and gender variance. So I just wanted to [indiscernible]

your experiences?
And I think that's very true. Because, like, back then, we saw that, but the research is not there. So now, the research is telling us up to
20 percent of the transgender kid will also have high-functioning autism. And I think in a way, that really tell us by [indiscernible] they're born this way, because they just happened to be - come with it.
And -- but having said that, a lot of times when we detect there is some signs that he kid may be autism related also on top of those, and we will always, in our clinic, we will do the autism assessment too. But if it's not in our clinic, we will encourage the parent to find someone to get that done. Because if it's 20
percent, up to 20 percent, I think it's quite significant. And majority of them we see is high-functioning autism. So what that means is they have some subtle sign. And a lot of time they go through the radar, and parent and the school didn't detect it until too much later.
Yes?
Q So in the tier one that you talked about assessing the things like depression

[indiscernible] health disorders, are you able to tangle out, because transgender people can have those disorders because they're stuck being who they're not.
A Yeah, definitely.
@ Are you able to tangle out what is .- like, to be able to support that child either way so they can be who they are?
A Yeah. I think definitely. I mean, there's a couple possibility here. Some of the kids can be, like, genuine, just depressed, but nothing related to being transgender. Or the kid. like you say, is depressed because I'm trapped in this body. That is gender related. Or the kid can be, like, I'm depressed trapped in this body, but I also have concurrent depression going on.
So all three can happen. I think that is assessment that will really determine what that is. Because sometime when we do the assessment, the test is telling us that the kid is in the clinical range of the depression, so we will be full of, Hey, we want to know what are the contributing factors to your depression? Are we talking about just depression? Are we talking about because of gender incongruence? Or are we talking about a combination of both? So that would be something to look into.
Yes? Yes?
So I was wondering, because you imply that there is there is something or the videos
[indiscerniblel and implying that there is something in the wiring in the brain that children from a very age know about
[indiscernible].
So I was wondering from your experience, are there cases of young adults or.
yeah, even like, 20s or 30s, that they're only now beginning to have these thoughts and having doubts of it?
A Yeah. I think that's a good question. Because, like, I think that we -- I don't know if it's a curse or blessing, having a young kid come up so early, 3 years old, I'm not a boy, I'm not a girl. I think that's good and bad, verses someone that have no sign, and then come out when they're 15 or 16, Viola, Mom, I'm a boy, I'm a girl. That kind of thing.
And it's interesting enough, 40 percent of my client, we call it silencer. That means the parent, no clue.
No indication. The kid didn't show them any sign. But that doesn't mean they don't have the feelings. Many of them, they have the feelings early on. They thought they would go away, so they try to ignore it. Many of them, they have the feelings, they were so ashamed of it, so they try to repress as much as they can.
Many of them, they have those feelings, but they don't know what that is all about until they learn something in later life. So I think that is assessment is all about.
The funny thing is, even though those silencers, we are always able to find out there is some indication, but maybe the kid just don't able to connect the dots together. And then we will present it to the parent, Hey, this is what's going on.
Anybody? Okay.
So thank you so much for coming. Okay.
Okay. One more.
One more. yes.
@ So from your experience, like, wee young kids that they, like, identify themselves as, like --
like, so as a girl I'm saying, I'm a boy, like.
what kind of, like, themes or indicators, like, this really young kid is giving, like, I'm going to play .= so, like. I'm a girl, but I want to play with, like, boys toys? Or, like, what kind of. like, indicators ••
I think that's a good question. If I'm looking for indicator, I prefer not to looking at because my boys like to play with girl toys and vice versa, because again, that's gender role, gender expression.
I more listen to them. Because that's the thing, that I want to be a girl, verses saying that I am a girl. There's a big difference. We look for the intensity. How consistent? We look at persistent, consistent, insistent. And that is a much better indicator than looking for what toys you play, who you're friends with, and you like playing with sparkly things or not.
So I would look for the consistent, persistent, insistent. That is a lot better indicator than looking for those.
DR. WONG: So thank you so much for coming and ..
UNIDENTIFIED SPEAKER: So as I mentioned on the way in, we have some handouts at the front here if anyone is interested. I noticed the anxiety and fear gone.
So [indiscernible] you can contact our office or have [indiscernible].
[END OF AUDIO]