A clinical psychologist assessed Max about a half-dozen times over a period of several months, beginning in Grade 8. By the end of those sessions, Sarah says the psychologist deemed Max to be a good candidate for testosterone therapy. According to B.C. health guidelines, Max needed to have demonstrated to the psychologist a “long-lasting and intense pattern of gender non-conformity or gender dysphoria,” among other things.
The only other thing Max needed was a referral from a family doctor, which his father agreed to obtain.
In August, Sarah and Max attended the B.C. Children’s Hospital’s gender clinic, one of the busiest in North America. There they met with a team of people, including a paediatric endocrinologist, a social worker and a nurse, who laid out in plain language what the treatment would entail and all the pros and cons. A three-page “informed consent form” spelled out the risks of testosterone therapy, including that the “treatment in young adolescents is a newer development, and the long-term effects are not fully known.”
The form indicated that testosterone use would likely lead to permanent changes — such as a lower-pitched voice, facial hair and thicker hair on the arms, legs and torso — even if the treatment stopped. Taking testosterone could also lead to elevated risk of heart disease, stroke and diabetes. “It is not known,” the form says, what the effects of testosterone are on fertility. “You may or may not be able to get pregnant in the future.”
Despite the risks, Sarah and Max signed the form that day and agreed to proceed with the treatment. After three years, Sarah says she had come to a clear conclusion: Max wasn’t going through some “phase.”
“If this is what alleviates my child experiencing this dysphoria, I’d rather move forward. … If it happens to have side effects down the road, we’re OK to handle that — at least our child would still be alive.”
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Hospital staff were ready to begin injections that same day, Sarah says — but she felt it would only be fair to let Clark, who did not attend the meeting, weigh in on the decision.
Clark, whose legal challenge was first reported in the alternative news website The Post Millennial, told the National Post he didn’t want to miss work that day and thought the visit to the gender clinic was exploratory. He says he was shocked to hear how quickly things were moving.
“I thought it was a long process and nothing drastic was going to really happen, at least without consent,” he says.
Clark did not sign the form. He felt the potential medical ramifications were too serious for someone Max’s age to take on.
“You don’t just jump them into things they can’t change back,” he says. “When she’s 18 and she does it, I’ll support her 100 per cent.” (During his conversations with the Post, Clark referred to Max as his daughter and used female pronouns.)