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Gender-affirming care comes with barriers and delays


Despite Canada’s progress in transgender health care, for more than 100,800 trans and non-binary Canadians, accessing gender-affirming care comes with barriers and delays that vary by province.

Fae Johnstone, trans activist and executive director of Wisdom2Action, a gay-owned advisory group working in transgender health, says that despite better national understanding of gender-affirming care, transgender health access seems to have “completely fallen off the radar of most provincial and territorial governments.

“We have a disparate system full of inconsistencies and a phenomenal small set of healthcare providers who go above and beyond to try to provide gender-affirming care,” she said in an interview Wednesday.

Each province and territory has its own set of regulations for accessing hormone or surgical treatment for transgender people – those whose gender is different from the sex they were assigned at birth – or for non-binary people, whose gender cannot be defined as male or female.

Johnstone says the Yukon and British Columbia are among the best Canadian jurisdictions for accessing gender-affirming care, while Ontario and Quebec fall somewhere in the middle. Atlantic Canada and the Prairies, meanwhile, “tend to lag further behind.”

In April, Statistics Canada reported that 100,815 Canadians aged 15 and older identified as transgender or non-binary, representing 0.33% of Canadians in that age group. Nova Scotia has the highest proportion of trans and non-binary people in the country, with one in 200 people age 15 and older identifying as trans or non-binary.

In Nova Scotia, barriers to gender-affirming care come from family physicians unfamiliar with trans health care, as well as a ‘cumbersome’ surgery request process, says executive director of Halifax Sexual Health Centre, Abbey Ferguson, in a recent interview.

Gender-affirming care, which can include hormone treatments and surgery, is something any family doctor or primary care provider can provide. However, Ferguson says the majority of Nova Scotia doctors refuse to offer gender-affirming care, which she says drives patients to the Halifax Sexual Health Center or prideHealth, which is part of Nova Scotia. Scotia Health Authority.

As of June 13, the Ferguson clinic had 850 patients seeking gender-affirming care and another 65 on its waiting list. Some of these patients, she said, ask to be referred for gender-affirming surgery, which includes surgery to create or remove breasts, called top surgery, or surgery to reconstruct genitalia, called bottom surgery.

To apply for these surgeries, Nova Scotians must first obtain at least three letters: a mental health assessment letter confirming that the patient has gender dysphoria and is capable of giving informed consent; a letter of support from a clinic or family doctor confirming that the patient will be cared for after surgery; and a letter from an endocrinologist, psychiatrist, or surgeon also assessing the patient’s mental well-being. For bottom surgery, a patient needs an evaluation letter from two of the three specialists.

The process of getting all the letters and being referred for surgery can take years.

“It’s very tedious, and that’s where the majority of the wait comes from,” Ferguson said, adding that only a handful of “overworked” specialists in the province typically write these letters and that the times of waiting to get each of the letters can take a long time. month.

Charlotte Landry, a 31-year-old computer technician and trans woman from Cole Harbour, is awaiting a surgery date after waiting more than eight months to see one of two Nova Scotia endocrinologists who are writing letters for surgery. gender affirmation.

Landry says she considers herself lucky because she has had a primary care provider who has been supportive of her gender-affirming treatment since 2019. That means she was able to start hormone treatment without too much delay. A friend of hers without a family doctor waited “several years” for the same treatment.

Landry says she understands the purpose of the first two letters, but the third — demanding that an endocrinologist review documents she’s already reviewed with her doctor — seemed unnecessary.

“There seems to be an assumption somewhere in the medical community that trans people can’t make their decisions or give informed consent without repeated psychological evaluation, which is a bit unfair,” she said.

Jenn Macgillvray, a clinical laboratory technologist at a non-binary Halifax hospital, joined the waiting list to receive the first letter required for gender-affirming surgery in June 2021 and will travel to Montreal for the intervention in September. Macgillivray, who uses the pronouns they/them, says they have no problem with the wait time that comes with surgeries, but they say the specialist letter requirement is a problem.

“It’s so annoying that I’ve been waiting and waiting and waiting for something that doesn’t make sense,” they said in a recent interview.

Macgillivray and their lawyer are preparing to file a human rights complaint against the province because of the requirement for a specialized letter, they said, noting that many provinces do not require this third step.

Nancy MacDonald, a prideHealth nurse who helps match trans and non-binary people with healthcare providers, says she receives about 100 emails a week from patients seeking gender-affirming care in Nova Scotia. Scotland.

Some of these messages are “very emotional, you can tell they are struggling so much and suffering so much and they don’t know where to turn,” she said in a recent interview.

“A lot of people said, ‘it’s life or death for me.'”

This report from The Canadian Press was first published on June 23, 2022.

This story was produced with the financial assistance of Meta and the Canadian Press News Fellowship.