It can be complicated to understand all the different pathways to accessing gender-affirming care in BC. The steps are similar for everyone: get a hormone readiness assessment recommending you for HRT and then find a prescriber, but who you choose to do both your assessment and your ongoing medication management is a matter of choice. The options are a little bit different depending on whether you are working with a private therapist or going through the public system, whether you have a supportive and knowledgeable family doctor or other prescriber, and whether you are over or under the age of majority.
Gender Affirming Care for Youth
For youth, the gender clinic at BC Children’s Hospital is a really important resource. This clinic offers social workers, psychologists, and pediatricians with lots of experience in providing gender-affirming care for youth. There is a lengthy wait for this service (often around one year). They can provide care, including assessment for puberty blockers and estrogen or testosterone based HRT until you are nineteen years old. They also provide other types of support, like support groups and education for family members. Many primary care providers prefer to refer youth to the BCCH gender clinic because they feel they do not have the necessary expertise in providing children and youth with gender-affirming care. For youth, some Foundry youth clinics also have gender-affirming care clinics. Foundry youth clinics are located in communities across BC, including Vancouver, North Vancouver, Langley, Abbotsford, Campbell River, Kelowna, Prince George, and others. These services are all covered by MSP.
How do I Get a Hormone Readiness Assessment?
If you are an adult and have a supportive and knowledgeable family doctor or other primary care provider, your doctor may be able to do a hormone readiness assessment and begin prescribing HRT. Other doctors may want to refer you to an endocrinologist, which typically has a wait of one to six months. The endocrinologist will do a hormone readiness assessment and stabilize your dosage of HRT before transferring your care back to your primary care provider.
Publicly Funded Clinics
Some people do not feel comfortable talking to their family doctor about HRT, or have a family doctor who says that they do not know enough about gender-affirming care to do a hormone readiness assessment or prescribe HRT. If you are seeking HRT in Vancouver and do not want to work with your family doctor or do not have a family doctor, you can either ask to be referred to a public gender-affirming care clinic such as Three Bridges Clinic, or choose to go to a private counsellor, therapist, or psychologist who offers hormone readiness assessments.
We Can Help
For those who would prefer not to wait for a referral to Three Bridges or another public clinic, working with a therapist in private practice may be a good option. Therapists such as our team at Stillwaters are knowledgeable about trans issues, and trained in completing hormone readiness assessments with sensitivity and care. By choosing a private therapist to complete your assessment, you may also have the option of choosing someone who has lived experience in the same community, which may add an increased sense of comfort and understanding. Some therapists may be available immediately to do an assessment, while others may have waitlists of a few weeks. In general, this option is faster than the public route. Private assessments are not covered by MSP. Some assessors may be covered by extended health benefits, depending on your coverage. You can book a consultation on our online booking page and start your assessment process today.
For people who are already working with a supportive therapist who has training in hormone readiness assessments, it can be a good option to go ahead and do your assessment with your existing therapist. Assessments involve sharing fairly personal information about your history of dysphoria and your mental and physical health, and it may feel more comfortable to do this with someone you already know and trust. After completing the hormone readiness assessment and receiving a recommendation for HRT, you can take your completed assessment to your family doctor, an endocrinologist, or another prescriber knowledgeable in gender-affirming care.
WPATH Standards
Whether you choose a primary care provider, endocrinologist, publicly funded clinic, or private therapist to complete your hormone readiness assessment, the steps may be similar. Each of these care providers is guided by similar standards, set out by the World Professional Association for Transgender Health (WPATH). You do not have to have a specific identity to be eligible for HRT or other types of gender-affirming care (ie. non-binary, genderqueer, and genderfluid people are eligible, not just trans* identified people). The standards include that you must demonstrate sustained dysphoria, that any physical or mental health issues must be well-managed, and that you have the capacity to give informed consent.
HRT and Mental Health
Some clients feel concerned that a history of mental health issues may prevent them from receiving HRT, but the WPATH standards are most concerned with what you are doing in the present to manage your mental health, and whether you have a demonstrated period of stability. If you have significant physical health issues, you and your primary care provider will need to decide together if they are well-managed, as this is not within the scope of practice of counsellors, therapists, or psychologists.
Whichever route you choose, the process of getting HRT should feel safe, respectful, and non-judgmental. Seeking gender-affirming care is a major decision, and you deserve support and kindness as you navigate the path to HRT.