B.C. doctor fined $28,000 for refusing to inject trans-identifying teen with puberty blocker

The British Columbia Human Rights Tribunal has ordered a B.C. family doctor to pay $28,100 in compensation for refusing to administer a puberty-blocking drug to a transgender-identifying teen over his religious beliefs.

According to the ruling, Dr. Henry Ajaero discriminated against the transgender youth by denying medical services based on gender identity.

“I am not persuaded that this was justified by (Ajaero’s) religious beliefs or lack of medical expertise,” tribunal vice-chair Devyn Cousineau wrote in finding Ajaero violated protected grounds under B.C.’s Human Rights Code.

The case involves a visit by “Child Q” to Ajaero at age 14. The ruling describes Child Q as a “brave, sensitive, kind transgender girl” who, in late 2020, “had come out as transgender and was struggling with puberty.”

At the mother’s request, Ajaero referred Child Q to a gender clinic at B.C. Children’s Hospital, where an endocrinologist prescribed Lupron. Regular injections of Lupron act on the brain to block the release of testosterone and estrogen and stop the body changes that come with puberty, such as breasts, broadening hips and menstrual periods in a child born female, and voice deepening, body and facial hair, muscle mass, and other changes in a child born male.

Puberty blockers have come under increasing scrutiny, including in the U.K, where a major review led to their ban for use in trans-identifying youth.

Lupron was meant to “pause” puberty and buy Child Q time to decide next steps, Cousineau wrote. “Child Q describes the day she started Lupron as ‘one of the best days of my life.'”

The drug is taken as an injection every three to four weeks. Child Q had the option of learning how to administer the injection herself, but preferred to have it done by a doctor, according to the tribunal decision.

An appointment was booked with Ajaero at his Delta clinic for March 5, 2021. That day, while mother and child waited to see him, Ajaero learned what the injection was for. According to the ruling, he told the mother privately that he would not administer it for “religious and cultural reasons” and said no one else at the clinic could do it. “Mother Q and Child Q were forced to leave without receiving the injection.”

In asking for Child Q’s complaint against him to be dismissed, Ajaero argued that providing any care related to “gender reassignment” is inconsistent with his religious beliefs and that administering Lupron was outside his scope of practice and expertise.

The case was also the subject of an investigation by the College of Physicians and Surgeons of B.C., which issued a formal reprimand against Ajaero in 2023 for refusing to provide care related to gender transition on the basis of conscientious objection without offering to help refer the patient to a willing provider.

According to the tribunal decision, Ajaero, who is from Nigeria, is a Christian who attends church every Sunday with his family and whose religion “is an important part of his life.”

During the period of the complaint, he ran a busy family practice. He became Child Q’s family doctor in 2017. Child Q came out as trans in the spring of 2020.

In the tribunal hearing, “she described herself as an ‘early bloomer,'” according to the ruling. “As her endocrinologist later noted, she was ‘dramatically affected by her progression through puberty.'”

“I had begun puberty fairly early on, so I was already feeling a lot of the effects of testosterone and what testosterone was doing to my body,” Child Q said in her evidence. “I can’t describe in words the amount of pain that caused me.”

Child Q was referred to a youth gender clinic. Ajaero agreed to make the referral, according to the ruling.

Throughout his treatment of Child Q, Ajaero and clinic staff “continued to use he/him pronouns and (Child Q’s) deadname,” which the tribunal said “demonstrates a lack of care, understanding and sensitivity towards a vulnerable trans child.”

In her written decision, Cousineau said she “corrected Dr. Ajaero’s chart notes to properly reflect Child Q’s gender.”

The youth’s mental health worsened. “She was self-harming. She had suicidal thoughts, with a plan,” and was hoarding Tylenol, according to the ruling.

Ajaero said he only discovered the day of the March 2021 appointment that the visit was for a Lupron injection. Mom and child were kept waiting nearly two hours.

“He understood — wrongly — that this was part of a process for ‘gender assignment therapy,'” according to the decision. He said he had no experience with that branch of medicine and that, because of his religion, found it “conflicting and difficult” to be involved.

He asked if Child Q’s mother was “OK” with his decision. “Mother Q said it was not OK, and they needed to get the shot that day,” according to the ruling. “Mother Q asked if there was someone else who could do it, and Dr. Ajaero said no.

“Mother Q stormed out. She told Child Q they were leaving, and they left. They never spoke to Dr. Ajaero again outside legal proceedings.”

Child Q received the injection later that day at a walk-in clinic.

The tribunal said intramuscular injections fall within a family doctor’s everyday scope of practice and that Ajaero was prepared to administer the shot “until he learned what it was for.” Although Lupron is part of gender affirming care, “it was not a treatment for ‘gender reassignment.'”

Ajaero runs a busy practice with around 2,800 patients and “made a quick decision in the context of a busy day” during the height of the pandemic and with “incomplete information,” according to the decision. He felt uncomfortable and unprepared administering Lupron, and the tribunal accepted that his decision wasn’t based on an intention to discriminate against her.

However, in addition to not persuading her that Lupron fell outside his scope of medical practice, Cousineau said she was not persuaded that there was a bona fide and reasonable religious justification for denying Child Q the injection.

Ajaero told the tribunal, “I believe in God created man and woman. And I find it difficult to be involved in anything against that.”

But Cousineau found that the evidence “does not establish that refusing to administer medication whose purpose is to suppress puberty in trans youth is a particular line of conduct called for by Dr. Ajaero’s religious custom or connection to God.” Puberty suppression, she said, “does not, on its own, conflict with Dr. Ajaero’s stated religious belief that ‘God created man and woman.'”

Ajaero had also agreed to refer Child Q to a gender clinic. “Dr. Ajaero has not explained why administering an injection of Lupron — a medication prescribed and overseen by another doctor to pause puberty — crosses the line.”

Ajaero tried to limit publication of information that could identify him or his clinic, arguing the case was likely to attract “prurient” media and online attention and that it would be reasonable to expect he would be subject to online criticism, including possible threats of harm.

“The difficulty I have with this argument is that there is no evidence to suggest that Dr. Ajaero may face threats because he refused to give Child Q gender affirming care,” Cousineau wrote in denying his application.

“The cases that address threats against doctors are about doctors who give gender affirming care. I am not prepared to assume that the public response is the same to doctors on both sides of the issue.

“To the extent that Dr. Ajaero experiences consequences from publication, they flow from his conduct, which I have found discriminated against Child Q.”

Ajaero was ordered to compensate Child Q for expenses incurred and for “injury to her dignity, feelings and self-respect.”

National Post