Caught in the Middle: Health Care Providers Navigating Politics, Policy, and Practice in Gender-Affirming Care for Youth

Abstract

The provision of gender-affirming care (GAC) for transgender and gender-diverse youth in Canada is increasingly shaped by the complex intersections of politics, policy, and clinical practice. As demand for hormone replacement therapy grows, health care providers often find themselves “caught in the middle” of competing obligations- balancing evidence-informed practice, ethical commitments, institutional constraints, and rising political scrutiny. Despite Canada’s reputation for progressive GAC, providers continue to face inconsistent provincial policies, bureaucratic gatekeeping, and risk-averse environments that generate uncertainty and fear, even within affirming settings. Drawing on peer-reviewed literature, professional guidelines, policy documents, and sociopolitical texts, this discussion paper uses Critical Social Theory to examine how structures of power and institutional control influence the delivery and restriction of youth-focused GAC. Through this lens, the challenges facing clinicians are revealed not as isolated dilemmas, but as manifestations of broader systems of domination and resistance within health care. The paper argues that the politicization of GAC threatens provider decision-making, undermines youth trust and equity, and calls for depoliticized clinical environments alongside policies that protect providers and meaningfully include youth voices in shaping equitable models of care.