Wait times for trans and gender nonconforming people in Nova Scotia wanting to receive gender-affirming hormones are a major barrier – somewhere between eight and 12 months. New online trainings being offered by CBRC and prideHealth are helping to improve access in the province by increasing the number of physicians and nurse practitioners trained on gender-affirming care.
“Long wait times are a critical problem,” says Kirk Furlotte, CBRC’s Atlantic regional manager. “Accessing gender-affirming hormones in a timely fashion is crucially important for trans and gender nonconforming people’s health and wellbeing. Studies have repeatedly demonstrated that mental health issues such as depression, anxiety, and suicidal thoughts decrease once trans health care is initiated. Long wait times are an urgent problem that needs to be fixed.”
The situation in Nova Scotia typifies the overall situation in Canada. Despite some improvements in trans health care in the country, major gaps continue to limit access for trans and gender nonconforming people. These gaps are systemic: healthcare providers are often not exposed to specific training on how to deliver effective gender-affirming care, despite the desire among many to treat patients of diverse gender identities. And with so few providers receiving specialized training, trans and gender nonconforming people typically face long wait times to begin hormone therapy, and an inability to access care outside of urban centres.
In Nova Scotia, a large part of the delay had to do with most of the gender-affirming care being centralized in one place: the Halifax Sexual Health Centre. The clinic had become the default space to access services due to the expertise of their staff, as well as the lack of adequate training among other healthcare providers in the province. “The centralizing of services also created an additional obstacle for those living in rural regions since they needed to travel up to four hours each way just to be seen,” says Furlotte. In Nova Scotia, 43 per cent of the population lives in rural areas, making the centralization of care in Halifax a significant barrier.
To increase access, CBRC partnered with prideHealth (a program of Nova Scotia Health in partnership with the IWK), to create a free online training program for primary care providers on how to better support their trans and gender nonconforming patients. Originally, the training was planned as an in-person workshop but was shifted online due to COVID-19. Having the training online led to higher-than-expected uptake, with the presentations being accessed by doctors and nurses across Canada. The three-hour course includes recorded presentations by professionals, a panel discussion with healthcare providers and people with lived experience, and an online quiz. For physicians, the course also offers professional accreditation hours.
“Once a sufficient number of primary care providers in Nova Scotia had taken the online courses, the Halifax Sexual Health Centre called patients on the existing waitlist to refer them to prideHealth’s new primary care referral network so that they could be seen more quickly,” says Furlotte. The result of this initiative has been a significant increase in the health system’s capacity to prescribe gender-affirming hormones. Fully 350 primary care providers from across Canada had registered for the continuing education courses by February 2021. In the first year, prideHealth’s referral network included over a dozen providers in Nova Scotia to address the gaps in gender-affirming hormone availability.
Most crucially, this has led to a reduction in wait times for trans and gender non-conforming people seeking gender-affirming hormones at the Halifax Sexual Health Centre. According to Abbey Ferguson, a health promotor at the clinic, the trainings have led to wait times being reduced to 1-3 months at times. The wait times, however, do jump back up once available resources are filled. “When that happens, we can now refer people to the trainings. If a person has a family doctor who perhaps doesn’t know how to give gender-affirming care, or doesn’t have the confidence to, we can provide the link to the training and then they too can be added to the registry.”
As the evidence shows, reducing wait times for gender affirming care is critical to the health and wellbeing of trans and gender nonconforming people. “We know this is just one small part of the puzzle, but we’re happy to work to close the gap,” says Furlotte. “Still, systemic changes are needed so that community-based organizations don’t shoulder as a great a burden for helping to provide adequate care.”
Based on the success of this model, CBRC has also just launched a new training on surgical readiness and aftercare. The free course is primarily intended for primary care providers (physicians, residents, and nurse practitioners) who can fill complete surgery coverage applications and provide post-operative care, but all healthcare professionals are welcome to take the course.