2SLGBTQQIA+ Knowledge

About 2SLGBTQ+

2SLGBTQ+ is an acronym for two spirit, lesbian, gay, bisexual, transgender, and queer. The + acknowledges all other gender identities and sexualities not captured by the acronym, including questioning, intersex, asexual, pansexual, and others.

2S

2S: refers to ‘two spirit’ which is a term that incorporates Indigenous views of gender and sexual diversity and encompasses sexual, gender, cultural, and spiritual identities. The term two spirit may be used among some Indigenous communities/peoples rather than, or in addition to, identifying as LGBTQ+.

However, not all sexual and gender diverse Indigenous people consider themselves to be two spirit. Two spirit people have historically been an important source of cultural knowledge and have held important roles in governance structures, although these valued roles have been suppressed through the long process of colonization. The cultural, social, and spiritual roles of two spirit people may vary and are specific to each individual community. Due to cultural and spiritual context, the term should only be used to refer to Indigenous people.

L

Lesbian: A person who is primarily attracted to people of the same gender. It is most often used for women who are romantically and/or sexually attracted to other women.

G

Gay: A person who is primarily attracted to people of the same gender. Although it can be used for any gender, it is most often used for men who are romantically and/or sexually attracted to other men.

B

Bisexual: A person who is attracted to more than one gender (including non-binary and gender-diverse people).

T

Transgender: A person whose gender identity does not align with their assigned sex and birth. (By contrast, cisgender people feel that their gender identity aligns with their assigned sex at birth.) People who identify as transgender may or may not choose to undergo gender confirming surgeries, and they can identify with any sexual orientation.

Q

Queer: is an umbrella term that refers to different kinds of sexual and gender identities beyond heterosexual or cisgender. Queer was historically used as a derogatory term but has been reclaimed by many groups as a way of self-identifying and/or as a political statement against oppression.

+

This sign encompasses all gender identities and sexualities not captured by the 2SLBTBQ+ acronym, including but not limited to:

Asexual: A person who does not feel sexual attraction or desire to any group of people.

Questioning: A term used by some people to describe their sexual orientation as being a process of exploration and discovery.

Pansexual: A person who experiences attraction to people of varying gender identities and sexual orientations.

Intersex: A person whose biological sex is neither distinctly male nor distinctly female, or is both. Some cultures recognize up to 7 genders, with distinctly male on one end and distinctly female on the other end.

Gender-fluid: A term used to describe people whose gender identity is not static.

Non-binary: A term with multiple meanings which is often used by a person whose gender identity does not align with a binary understandings of gender such as ‘man’ or ‘woman’.

Non-gendered or agender: A term used by some people who do not identify as having a gender. Some folks who identify as non-gendered or as agender do so to critique heteronormative assumptions and societal expectations that support and/or promotes heterosexuality and a strict gender binary as the only natural and acceptable expression.

Professional Resources and Networking for Indigenous Youth and Young Professionals

Generation 4 Equality Fact Sheets

2SLGBTQQAI+ Gender Affirming Care for Healthcare Providers

What is gender-affirming care?

Gender-Affirming care is the care that supports a client, patient, or service user’s experience that is appropriate for their gender and/or sexual orientation. Having a positive, affirming and respectful experience is important for anyone accessing health or social services, but it is especially important for 2SLGBTQQAI+ individuals accessing health or social services. These experiences have a direct impact on health and wellbeing and if the services will be accessed again. As a healthcare provider, providing gender-affirming care fosters a trusting and inclusive environment. A positive experience means service users are more likely to be open and honest about their experiences and needs. A negative experience’s possible outcome may inhibit an individual from accessing preventative and necessary care. Gender-affirming care is life saving healthcare.

What does this include?

First point of contact employees should have the knowledge and capacity for a positive and affirming experience of 2SLGBTQQAI+ service users. Interactions with employees of these settings at any level can indicate treatment of 2SLGBTQQAI+ individuals. It is imperative that first point of contact employees are able to be respectful of desired pronouns (including use) and personal experiences (that are gendered and related to sexual orientation).

When new service users access health or social services it is important to have intake forms that reflect the diversity of the population. Intake forms are one of the first steps in accessing services. Make space for preferred names and pronouns. Avoid using gendered language and instead use terms like people with a uterus or chest-feeding. Provide options that are outside the gender binary.

A comfortable environment will ease people accessing services. Pride Flags or posters support a safe space for all to access are essential for informing individuals that this is a space that they can use safely. Avoid gendering washrooms or provide an all-genders washroom. Inform new service users or post that there are policies that are enforced to provide a non-discriminatory service and ensure that all staff have applicable knowledge, training, and awareness of policies. Support from families is beneficial but respecting the individual’s choice of this involvement is key.

What should appointments look like?

As a healthcare provider or social service provider you have a duty in your actions to ensure that you are promoting a positive and welcoming space for 2SLGBTQQAI+ individuals accessing services.

  1. Never assume that a person is heterosexual or cisgender, these perceptions can be harmful and invalidating and starts rapport on negative note.
  2. Use open-ended questions to engage and find further information and do not assume experiences. Individuals are the expert on their own bodies and should have autonomy when it comes to disclosure and decisions surrounding their treatment plan.
  3. Be sure to be knowledgeable about the health and social determinants of health that affect 2SLGBTQQAI+ individuals, this will ensure that wrap-around care and a holistic approach is centred to benefit the individual. This also ensures that other intersections of identity is not being overlooked such as age, race, ability and socioeconomic status.
  4. Provide services with a trauma-informed approach by checking in with the individual and making sure that the experience is beneficial for them. Pay attention to the language that is used by the individual describing their body and care that they are receiving and have received.
  5. Take accountability for mistakes and be open to discussion on how to move forward and feelings around this.

What knowledge of practises should you be familiar with?

2SLGBTQQAI+ individuals may seek medical or social assistance in aligning with gender identity. Gender dysphoria is feelings of discomfort or stress related to a person’s gender identity this is because the person’s gender identity does not align with the sex assigned at birth. This may appear at any age or stage in a person’s journey. Individuals may request medical interventions to help with gender affirmation as well as social interventions with care providers that are knowledgeable with education on processes and counselling. An individualized approach is essential in these services. It is important to understand the risks of treatment but also the risks of withholding treatment.

Hormone Replacement Therapy is a collaborative endeavor that requires a positive relationship with a medical provider. Hormone Replacement Therapy helps with bringing appearance in line with gender identity. This therapy involves taking prescriptions to increase hormones and block other ones such as Testosterone-based hormone therapy and Estrogen-based hormone therapy. Youth are able to access Hormone Replacement Therapy without the consent of caregivers. Assessment is conducted over a couple of visits. Number of visits is determined by physical and mental health of the individual seeking treatment. If you as a healthcare provider are not able to competently support Trans individuals or other gender diverse individuals, please refer to designated specialists.

There are a number of gender-affirming surgeries that individuals may choose. To access publicly funded surgeries, individuals need to meet WPATH criteria and psychosocial readiness. You must be a qualified provider to assess individuals. Specific training and supervision are required to qualify. Once assessments are completed you are able to refer service user’s for procedures. If you as a healthcare provider are not able to competently support Trans individuals or other gender diverse individuals, please refer to designated specialists.

PrEP and PeP are primarily used for the prevention of HIV exposure but there are also other reasons that one might wish to access preventative treatment such as measures to control one’s own sexual health and reduce anxiety about HIV exposure. Pre-Exposure Prophylaxis is a medication routine that is most beneficial when taking the prescription up to 4x a week becoming 99% effective[1]. There is public funding for individuals to access PreP. PeP, Post-Exposure Prophylaxis is used when an HIV negative person might have come into contact with HIV. PeP must be taken within 72 hours of exposure and conducted over a period of a few weeks. Some provinces have subsidized cost for these medications and some provinces provide them for free. If you as a healthcare provider are not able to competently support Trans individuals or other gender diverse individuals, please refer to designated specialists.

Along with medical supports, social supports may be needed for Trans and gender diverse individuals. Rainbow Health Ontario provides a directory of listed social service 2SLGBTQQAI+ providers which can be consulted here: https://www.rainbowhealthontario.ca/lgbt2sq-health/service-provider-directory/

Indigenous Individuals can receive gender-affirming health benefits from the First Nations Health Authority. Many gender-affirming surgeries are covered under these benefits as well as some medical supplies and travel expenses. If an individual is not able to access benefits from the First Nations Health Authority, expenses can be expended through the federal Non-Insured Health Benefits Program. Alternative funding may also be covered through association with Individual Bands. Although these benefits are for Indigenous individuals that have registered status some individuals may meet the criteria to be registered and support could be given to have this. It is important to keep in mind that status has been used as an exclusionary practise historically and criteria has and can change.

For more information as a healthcare provider or social service provider please refer to the following link: http://www.phsa.ca/transcarebc/Documents/HealthProf/Primary-Care-Toolkit.pdf

2SLGBTQQAI+ Gender Affirming Care for Service Users

What are the gender-affirming options?

There are a few options to help you with your gender expression and gender identity, if you so choose. Whether you choose to access these options or not is entirely up to you. Your gender identity and gender expression is completely individual. Choosing to not access these options also does not make you any less of the person you are and aspire to be. You are in control of how expressive and visible you choose to be. The following are options that may help with your expression and identity:

You might be aware that there are medical capabilities to help align your gender identity. If this is something that you are interested in then researching and understanding what your desired outcomes are, is your first step in the process. Contact your primary healthcare provider to see how they can support you with a medical transition. If you are comfortable enough to do so, be open and honest about what kind of treatment you are looking for. If you are more comfortable speaking to a specialist or provider with their own lived experience, your primary healthcare provider can refer you to someone else. Everything is assessed on a case-by-case basis and support from your family may be beneficial if that is something that is helpful and healthy for you.

Surgical care can have benefits for some individuals. Depending on your age and stage of development some surgeries may be better suited for you. Upper body surgeries may be more suitable for youth under the age of majority depending on the length of your transition. No one else can dictate the validity of your transition but assessments and criteria still need to be met for access to surgeries. There will be lots of questions for you to answer but answering as open and truthfully as possible will help the process. If at any time you find that the healthcare provider you have is not adequately supporting your needs and desires, you have the right to ask for a referral or alternative provider that may best suit you through out this process.

You may be familiar with the hormone related therapies such as estrogen-based therapy and testosterone-based therapy. You may also be familiar with puberty suppression medication which is also a prescription-based option. These prescriptions work by increasing certain hormones in the body or blocking them. Depending on assessments, some youth do not need parental permission to access this treatment. In Ontario, physicians can prescribe these therapies to youth. In some cases, hormone therapy is primary health care. These therapies may be beneficial to some individuals but not all.

PrEP and PeP are primarily used for the prevention of HIV exposure but there are also other reasons that one might wish to access preventative treatment such as measures to control one’s own sexual health and reduce anxiety about HIV exposure. If you wish to be preventative and or want more knowledge on HIV and prevention contact your primary healthcare provider. Regardless of sexual partner, HIV is transmitted through bodily fluids. It is important to keep up to date on testing and treatments to best support your health and your sexual partner(s).

What is covered?

Provincial coverage

Depending on your location, your province may have varying levels of coverage for gender affirmation treatment and supports. Most services and treatments should be covered under the provincial coverage granted to inhabitants. For example, in Ontario OHIP covers hormone therapies and some surgeries. British Columbia and the Yukon are known to have some of the best coverage. Check with your Provincial Health Authority website to see what specific gender-affirming care is offered and covered.

First Nations coverage

Indigenous Individuals can receive gender-affirming health benefits from the First Nations Health Authority as well as mental health support. Many gender-affirming surgeries are covered under these benefits as well as some medical supplies and travel expenses. They also can provide gender affirming items such as binders, packers, dialators, breast forms, gaffs etc. Medications including medications for hormone therapy are offered as well. If an individual is not able to access benefits from the First Nations Health Authority, expenses can be expended through the federal Non-Insured Health Benefits Program. Alternative funding may also be covered through association with Individual Bands.