Affidavit - Defending Alberta's Policies

The following affidavit has been sworn as of today (November 29, 2024) in defence of Alberta, Canada’s new policies protecting sex nonconforming minors from medical harm, and protecting women’s sex-based rights.

Read more about these policies

My personal experiences with gender incongruence

1. My name is Aaron Kimberly, born in Portage La Prairie, Manitoba in 1973 as a girl named Kimberly Outhwaite. From about aged three, I was observably gender nonconforming with a preference for more male-typical toys, Halloween costumes, and play styles like wrestling. Though I knew I was a girl, I had a strong sense of incongruence throughout my childhood which I didn’t understand and couldn’t articulate. This in itself however, didn’t cause me much distress. I was given leeway to be a tomboy and had many friends, both male and female, but this became more troublesome as I reached adolescence. At puberty, my body was both feminizing and masculinizing – e.g. I developed both breasts and facial hair. My gender nonconformity became recognized by others as being a lesbian and I learned that word for the first time because it was often used as a slur against me. Most friends started to bully me for this. My parents discovered that I had a crush on girl when my mom found a letter and my journal hidden in my closet. They found my homosexuality unacceptable and took me to our family doctor in Swan River, MB for a diagnosis. The doctor ordered bloodwork and did an interview with me, asking questions such as what role I imagined for myself in relationships. Following these assessments, the doctor had many meetings with my family that I wasn’t aware of until very recently. My family was told that I had a rare intersex condition called an Ovotesticular Disorder of Sex Development (OT-DSD) which he believed may be the result of chimerism (one twin absorbing another twin in utero, resulting in two sets of DNA in one person). My family did not disclose this information to me at the time. Regarding my same-sex attraction, about two months after my interview with the doctor, I found admission papers for ECT conversion therapy in a drawer in the kitchen. Thankfully my parents never followed through with subjecting me to ECT.

2. Due to the severity of homophobic bullying and social isolation, I developed depression and such severe social anxiety that I became almost entirely mute.

3. I first learned about my Ovotesticular DSD in 1992 at age 19. I was having severe gynecological pain due to a large grapefruit-sized cyst on my left ovary. I had this surgically removed, along with the gonad, which was sent for biopsy. The biopsy report revealed that the gonad contained both testicular and ovarian tissue.

4. I connected with the lesbian community in 1988 at age 16. In a rather desperate state of isolation, I’d reached out to the Gay & Lesbian Resource Centre in Winnipeg and was put in touch with a peer who I became friends with and visited when I was able to take a bus to the city 8 hours away. I moved to Winnipeg at age 18. Contact with the lesbian community started to help me to understand that my gender non-conformity is common among lesbians and gay men. I even met other butch lesbians with facial hair due to polycystic ovarian syndrome and congenital adrenal hypoplasia, which, like my OT-DSD, expose the female body to high levels of testosterone. Though I continued to feel a sense of incongruence, I was eventually able to integrate that into a butch lesbian identity.

5. As an adult lesbian, highly visible as such due to my gender non-conformity, I had experienced job losses and lost housing opportunities. My first job as an adult was for an advertising department. I was told by a manager on a regular basis that I was sinful for my same-sex attraction. He started to assign me projects designing Christian documents in a pointed attempt to correct me. My long-term partner and I were declined a spot in a housing co-op when we showed up as a lesbian couple. We were told outright that they wanted to give the unit to a heterosexual couple because they needed a man to do maintenance. It wasn’t uncommon for me to experience harassment in public, such as men screaming things like “fucking dyke” out of car windows.

6. In 2000, my partner of 9 years was in a horseback riding accident, suffering brain trauma which changed her and her communication style in ways that strained our relationship.

7. In 2001, a gay male neighbour Aaron Webster, was murdered in a deliberate gay bashing in Vancouver. He’d lived two blocks away from me and I was devastated and terrified by this.

8. In 2005 my partner gave birth to our daughter, which added to the strain in our relationship and we parted ways in 2006.

9. It was at this point, in 2006, that I saw a documentary on TV called “Trans Kids” in which the kids described a sense of incongruence just like mine. The documentary framed this as: if you experience this incongruence, it means that you’re transgender. I turned to my girlfriend and said “that’s me”. She said “I know”. Her best friend was a social worker at the Three Bridges gender clinic in Vancouver, BC, and got me booked for an appointment right away. The assessment took place over a two month period (approximately 5 sessions) with a general practitioner, Dr Culham. The assessment covered my childhood experiences of incongruence and some of my goals for transition, and reviewed the known risks such as high cholesterol. A diagnosis of Gender Identity Disorder was made, with no explanation of what that meant and no exploration of the homophobia I experienced or the life stressors at the time, and no suggestion of psychotherapy. I was then started on testosterone. Prior to any surgeries I was assessed again by a clinical psychologist, Dr Preece, who did a single visit screening for a wide range of mental health conditions which ruled out everything except depression and anxiety. I then had a double mastectomy by Dr Bowman and a hysterectomy by Dr Tregoning. Prior to genital surgery, I was seen once by a general practitioner, Dr Townsend, and a nurse practitioner at Three Bridges who told me that they were only there to support me. They asked basic questions about my overall health and functioning and about logistical things like who would support me following the surgery. I was told that the surgery outcomes by the clinic in Montreal were so poor that they were sending patients out of country. I was approved for and had a metoidioplasty by Dr Crane in Austin, Tx, in 2018. After the surgery, I was told that I hadn’t been a good candidate. I experienced complications from the metoidioplasty, in which an urethral extension had been created through the neophalus. Two areas of the urethra split open which required further surgery to repair. At no point from 2006 to 2018 had anyone done a physical exam to determine if I’d been a good candidate for the surgery.

10. Though I have functioned well in most areas of my life very well since medicalizing to appear as male, the social aspects have been more challenging. Since I was socialized female and still retain an awareness of myself as female and same-sex attracted, I don’t entirely integrate into male spaces, but nor do I integrate into women’s spaces. I lost many of my connections with lesbians, and romantic relationships have been especially complicated. The quality of my romantic partnerships has significantly declined due to misread cues and new expectations as a man.

My Professional Experiences as a Mental Health Nurse

11. I have worked as a nurse in various settings including a hospital psychiatric unit at St Paul’s Hospital, the British Columbia Provincial Eating Disorders Program and a youth-focused clinic called Foundry, in which I was a clinical supervisor for a walk-in counselling program. It was at the youth clinic in Kelowna BC where I began providing gender affirming care.

12. I was receiving training and clinical mentorship by Trans Care BC in gender affirming care in 2018-2019 and assessed approximately 50 young clients between the ages of 12-25.

13. The training I received was discouraging comprehensive assessment and psychotherapy. I was informed that a diagnosis of gender dysphoria was no longer a requirement and that the purpose of the brief assessment was only to determine a patient’s capacity to consent. My questions about gender dysphoria and the known pathways to gender dysphoria, as outlined in the current Diagnostic Manual (DSM-5) were met with hostility. I was told that conversations about gender dysphoria was pathologizing and that any mention of transition regret is transphobic, though I personally know several people who do regret medicalizing. Because I was doing more comprehensive assessment and had concerns about the appropriateness of some of my patients medicalizing, I was accused of “gatekeeping” services. Complaints were made to my employer and I was removed from my role, and activists publicly smeared my reputation and boycotted our clinic.

14. Most of the young patients I assessed were highly complex, often with severe mental health conditions. When assessed, many youth had difficulty conceptualizing their future, and seemed unable to fully comprehend the health risks. 71% were natal females, most of whom were same-sex attracted. 19% had an autism diagnosis. 29% had an ADHD diagnosis. 14% were in foster care. 15% had known trauma backgrounds, including sexual trauma. One patient was in active psychosis. Many of the patients had no childhood history of gender nonconformity. I became very concerned about the safety of fast-tracking those young people into permanent medical interventions.

15. Through my clinical work, I’ve learned about the developmental model of understanding gender dysphoria. Per the DSM-5, there are three known pathways:

• 16. Childhood onset – highly correlated with later homosexuality

• 17. Late onset – transvestic disorder with autogynephilia

• 18. Disorders of Sex Development related

19. There are 13 studies to date which tracked the trajectory of the childhood onset type of gender dysphoria. All of these studies found that the children who once believed they were the opposite sex, or wanted to be the opposite sex, typically shed off those beliefs by or through adolescence as they develop a gay or lesbian identity. I’m not aware of any studies which contradict those findings. According to development psychology research, a childhood sense of incongruence is a normal and common developmental aspect of homosexuality.

20. There is no known pathway for natal females to develop gender incongruence as adolescents or adults, because transvestic disorders with AGP only apply to heterosexual or bisexual men.

21. Having now developed a clinical understanding of gender dysphoria and the known pathways, my understanding of my own sense of incongruence has changed.

22. Girls exposed to testosterone during development are more likely to demonstrate male-typical social behaviours and occupational interests, and are more likely to be same-sex attracted. Since my OT-DSD did expose me to testosterone during fetal development and through early life, my behaviour and sexual orientation are most likely related to my medical condition. My sense of childhood incongruence fits with the developmental model of emerging homosexuality, which I had integrated into a butch lesbian identity as a young adult, up until the point at which I saw the documentary which suggested that my experiences mean that I am a separate thing called trans.

23. Having done trauma work, I have come to understand that my distress was not due to being gender non-conforming, but due to the societal responses (homophobia) I experienced. I made the decision to medicalize during a period of my life in which I was experiencing an unusual degree of stress (my partner’s head injury, our breakup, the birth of my daughter and the murder of my gay neighbour). I no longer believe that medicalizing was necessary or appropriate. I now must live with permanent alterations to my body, as a butch lesbian.