Transgender patients can often experience health disparities due to stigma, isolation while seeking care, and discrimination. In many of the medical regulatory (College) and human rights complaints cases observed by CMPA, miscommunication creates or contributes to a negative experience for transgender patients. It is important for physicians to be aware of the ethical and legal considerations when providing treatment or when asked to provide treatment, to transgender patients, non-binary patients, and those experiencing gender dysphoria.
Understanding terminology
Transgender or trans describes a person whose gender identity does not correspond with the gender that they were assigned at birth. Transgender individuals may adopt a new name and new personal pronouns. Some transgender individuals undergo medical treatments or procedures to have their physical body match their gender identity.
Non-binary describes a person whose gender identity does not fit into the male/female binary, sometimes identifying with they/them pronouns.
Gender-diverse describes any individual with gender identities and gender expressions that differ from gender norms and includes transgender and non-binary individuals.
Gender dysphoria describes the psychological distress that an individual might feel, resulting from a feeling of incompatibility between the gender that they were assigned at birth and their gender identity. Patients experiencing gender dysphoria might identify as transgender, or might be contemplating this identity for themselves.
Human rights laws
All individuals have a right to access healthcare services without discrimination and harassment. Physicians must not discriminate based on gender identity or expression when providing medical services.
All provinces and territories expressly recognize gender identity as a prohibited ground of discrimination in their human rights legislation.
Statements by human rights commissions
Some human rights commissions have issued policies and guidelines addressing discrimination against gender-diverse individuals. These documents may be useful resources for physicians seeking to understand their legal obligations and can be found on the website of each provincial or territorial human rights commission. For example, the Ontario Human Rights Commission’s Policy on preventing discrimination because of gender identity and gender expression [PDF] expressly addresses issues related to gender-diverse individuals facing barriers to accessing healthcare services.
Legislation, policies and guidelines
Physicians should be aware of applicable legislation and relevant College policies that are generally related to equity and diversity in healthcare and specifically address providing care to gender-diverse patients.
The Canadian Medical Association’s Code of Ethics and Professionalism states that in providing medical services, physicians must “accept the patient without discrimination … such as on the basis of … gender identify or expression.” However, physicians have the right “to refuse to accept a patient for legitimate reasons,” and should not “overstep the limits of their knowledge and skills.”
Colleges also generally state that physicians must not refuse to accept a new patient, refuse to provide healthcare to an existing patient, or terminate a physician-patient relationship, on the basis of a patient’s gender identity. However, the refusal to provide specific treatment at a patient’s request does not, in and of itself, constitute discrimination.
Some Colleges have published guidance on creating safe and inclusive spaces for gender-diverse patients. For example, the College of Physicians and Surgeons of Ontario's Creating an Inclusive Space recommends using inclusive intake forms that allow patients to self-identify their gender identity, training front-line staff, explaining the medical rationale for asking sensitive questions to gender-diverse patients, and taking children and adolescents seriously when they disclose that their gender identity differs from their sex assigned at birth.1 The College of Physicians and Surgeons of Manitoba's publication Gender-Affirming Medical Care provides similar guidance.2 Restrictions on gender-affirming care for minors
Restrictions on gender-affirming care for minors
In Alberta, legislation restricts the provision of gender-affirming care to minors (i.e. persons under 18 years old) for the treatment of gender dysphoria. Sex reassignment surgery is prohibited for any minor. Hormone therapy is prohibited for minors under 15 years old and can only be provided to minors who are 16 and 17 years old with the approval of a parent/guardian, a psychologist, and a physician (both authorized to practice in Alberta).3 Physicians practicing in that province should be familiar with the legislation and the College of Physicians and Surgeons of Alberta’s Advice to the Profession on Gender-Affirming Care.4
In all other jurisdictions, gender-affirming care for minors is treated like any other medical care. Except for Québec, consent for gender-affirming care will depend on the minor’s capacity: whether their physical, mental, and emotional development allows them to fully understand the nature and potential consequences of the proposed treatment or lack of treatment. In Québec, the age of consent is generally 14 years of age for care required by the minor’s state of health. For elective care, parental or guardian consent is required if the procedure entails a serious risk for the minor’s health and may cause grave and permanent effects. If the child is below the age of 14, or does not have the capacity to consent, the consent of the parent or guardian, or a court order, is required.
Names and pronouns
Physicians must ensure that they communicate with all patients in a sensitive, respectful, and dignified manner. Gender-diverse individuals may express a desire to be called by a name that differs from their legal name, or to be referred by pronouns that match their gender identity. Physicians should accommodate any such requests and address patients using their preferred names and pronouns.
Declining to provide care
While physicians must not refuse to treat gender-diverse patients based on discriminatory reasons, they are not required to provide care that exceeds their scope of practice.
In an Ontario Human Rights Tribunal case, the Tribunal dismissed a complaint against a cosmetic surgeon who was accused of discrimination for declining to perform a labiaplasty and breast augmentation on two transgender patients. The Tribunal accepted that the surgeon did not have the requisite expertise to perform the operation.5 The Tribunal held that there was no obligation for physicians to obtain significant new qualifications and training to accommodate a transgender patient.
However, the Tribunal accepted that the surgeon’s style of communication was “abrupt and dismissive,” and observed that had he conveyed the reasons for not being able to treat the patients more appropriately, the complainant “may have found their visit to his office a much different and more positive experience.”5
A physician who feels unable to provide medical care to a gender-diverse individual because the patient’s needs are beyond the physician’s expertise or clinical competence, should consider referring the patient to a specialist for the elements of care that the physician is unable to manage directly. Physicians unwilling to provide specific care based on moral or religious views should comply with the conscientious objection requirements of their College, including providing the patient with an effective referral. The clinical decision for refusing to provide treatment should be communicated to the patient in a respectful, clear, and timely manner.
Changes to birth certificates and other official records
Some patients applying for a change in their gender as recorded on their birth certificate and other official government records may require a statement from a medical practitioner, including a treating physician, confirming that the patient’s gender as indicated on the government document does not correspond with the patient’s gender identity. CMPA members who have questions about how to respond to such requests may contact CMPA for individual advice.
Risk management considerations
- Familiarize yourself and your staff with applicable human rights obligations, applicable legislation, and relevant College policies on equity and diversity.
- Ensure that you communicate with all patients, including gender-diverse patients, in a sensitive and respectful manner. Be respectful of the patient’s choice of name and pronoun.
- If you are unable to provide the medical services requested because they are beyond your scope of practice or skill level or because of moral or religious convictions, comply with College requirements, including with respect to effective referrals
- Record your discussions with the patient and document the reasons for the decision or referral in the patient’s medical record.
- Contact CMPA for advice about your obligations in specific circumstances.
Additional reading
References
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Finan v. Cosmetic Surgicentre (Toronto) 2008, Ontario Human Rights Tribunal Case. Accessed August 20, 2026 from:
http://canlii.ca/t/1zrq0
