Ontario has banned clinicians from treating transgender children and youth with "conversion" therapy, a practice deemed unethical by major international medical and human rights organizations.
But what will that mean for doctors and clinics that specialize in counselling gender non-conforming kids and adolescents?
Conversion therapy, sometimes called reparative therapy, has been used by some practitioners — often religion-based — to encourage heterosexuality among gays, lesbians and bisexuals and to discourage those who identify as transgender from embracing their inner non-biological sex.
Ontario's new Affirming Sexual Orientation and Gender Identity Act, which was unanimously passed last week, prohibits doctors from using this type of therapy on LGBT kids and teens under 18, while delisting it as a covered service for adults under the province's health insurance plan.
"It sends an incredibly strong message to practitioners to stop doing it and to parents to be very careful when they're looking for help for their children," says Cheri DiNovo, the NDP MPP who sponsored the legislation.
Enforcement will be up to professional colleges that regulate doctors and other clinicians, based on a complaint being brought forward, she says.
Bill 77 was inspired by the December suicide of Leelah Alcorn, a 17-year-old Ohio transgender girl whose parents had taken her for corrective therapy. A note she left behind begged: "Fix society. Please."
"So that's essentially what we're trying to do," says DiNovo, who learned the practice of reparative therapy was more widespread than she initially thought.
"It is going on across Ontario and that to me was the most shocking aspect of this," she says. "I think it's safe to say it has gone on everywhere and that this will hopefully bring it to a stop."
For some clinics that specialize in helping youngsters with what's known as gender dysphoria, the new law will not alter current practice.
The Children's Hospital of Eastern Ontario doesn't try to convert or reconstruct a child's sense of who they are, says Dr. Stephen Feder, head of the institution's Gender Diversity Clinic.
"The approach we take is one of validation, exploration, getting to know the child and family in ways that helps all of us together as a team to determine where the child will go with this issue," Feder says.
But doctors do try to tease out whether other factors — such as depression, body dysmorphic disorder or another mental health issue —may be affecting a youngster's behaviour and identity. Research has shown that not all young children who express a sense of being the opposite gender grow up to be transgender adults.
It's not clear how the new law will affect the Gender Identity Clinic for children at the Centre for Addiction and Mental Health (CAMH) in Toronto, which has been treating young people for gender dysphoria for decades.
In February, CAMH initiated an external review of its program for kids and teens in the wake of widespread accusations from the transgender community that its director, Dr. Ken Zucker, and other clinicians were practising reparative therapy. Findings of the review are expected to be made public this fall.
"Some people thought —though our focus was always on the anxiety and depression and problems that children had —that we were doing conversion therapy," says CAMH's Dr. Kwame McKenzie, the medical director who oversees the clinic.
"But the aim has never been conversion therapy. That's not what we do and this bill will make no difference to that," asserts McKenzie, who nevertheless welcomes the legislation.
Jake Pyne, a researcher at McMaster University in Hamilton who focuses on transgender issues, says McKenzie's contention doesn't square with the years of studies penned by Zucker and colleagues at CAMH.
"The clinic's been critiqued for 30 years, so it is quite frustrating to hear people say 'No, no, we're not doing that,' because a cursory Google search indicates that there is a very big problem," Pyne says.
Despite the polarizing controversy, Feder believes all clinicians in the field sincerely want to help gender-questioning young people and their families, and he speculates that the impetus for conversion therapy was to alleviate the "difficult" consequences of being transgender as patients grow into adulthood.
"And those consequences are well delineated," he said.
For instance, a 2010 Trans Pulse survey showed half of transgender Ontarians live below the poverty line, making less than $15,000 a year, often because they are unable to secure employment. Many can't obtain housing and violence is rife: a national survey by Egale Canada found three-quarters of trans youth had experienced verbal harassment, while 37 per cent reported being subjected to some form of physical assault.
Research also found that 77 per cent of transgender Ontarians had considered suicide, while 43 per cent attempted to end their lives.
"But the issue was and is that those consequences are really a function of these kids being unwelcome in a transphobic society, as opposed to being inherent in their transgenderism," says Feder.
"Therefore, if we could help create a more inclusive, welcoming society, then these negative outcomes should diminish."