Providing gender-affirming care


Improving access to health services for trans
and gender diverse communities
The Report, Dec. 2018

Trans people have been historically underserved by the province’s health system, according to HSA member Lucas Wilson, who works as a health navigator for Trans Care B.C.

There are numerous barriers that trans people and gender diverse communities face when accessing health care. Wilson says that one of the largest barriers can be finding a health practitioner who is in a position to help them reach their gender-affirming goals. 

“So many doctors might not be aware that gender-affirming care is something that they can provide. They see it as specialized when in a lot of cases, it doesn’t have to be,” explains Wilson. “So folks might be told that they need to go seek health care elsewhere.”

Gender-affirming care expands beyond primary care. It is any kind of care that “respects a person’s gender and supports them to feel more in line with their identity, whether that is through medical transition, social transition, or having a provider who is knowledgeable and sensitive to the vast diversity of gender identities,” says Wilson.

Given the access gaps for trans people in the province, community advocates spoke up. “There was a lot of advocacy done by folks who were asking for better care and resources for trans folks,” says Wilson.

He says the creation of Trans Care B.C. was a response to that advocacy. Following consultation and engagement with clinical experts and stakeholders from trans communities, Trans Care B.C. was launched to support transgender and gender-diverse people in accessing equitable health care services.

Operating under the Provincial Health Services Authority (PHSA), Trans Care B.C. is working with community partners, regional health authorities, and the Ministry of Health to develop a provincial network of services for trans people in the province. It helps care providers build their capacity to provide gender-affirming care. In support of trans patients, Trans Care B.C. funds peer-led initiatives, such as trans support groups.

Prior to the launch of Trans Care B.C., Wilson worked for the Trans Health Information Program, a program out of Vancouver Coastal Health that was folded into Trans Care B.C. As a health navigator, Wilson assists providers and patients in challenges pertaining to trans health care.

“We help troubleshoot with providers and with patients to get them to the care they need if they are running into barriers,” he says.

Understanding service gaps

Wilson says there are gaps in cultural competency among health service providers. Cultural competency may mean, for example, understanding that some patients don’t use their legal names. It could mean avoiding assumptions regarding the pronouns patients use.

“That is the baseline gap, because if you don’t feel comfortable accessing a service, or don’t feel respected in a space, you might not access care there,” says Wilson. 

Wilson says another service gap is access to medical transition, such as hormone therapy. If a doctor does not feel comfortable providing this medical service, they might refer the patient onward.

“Sometimes folks are put in a position where they need to pay privately to get the necessary assessments in place to start hormone therapy.”

To help address this gap, Trans Care B.C. has produced a primary care toolkit for doctors seeking to provide hormone initiation directly.

Access to reconstructive gender-affirming surgery is another gap facing trans people. Currently, those seeking lower surgery are required to travel to Montreal or the United States for the procedure, resulting in additional medical risks and financial costs.

The B.C. government reports that approximately 100 people travel outside the province annually in order to access lower surgeries.

However, this is set to change. The province announced in November that starting in 2019, Vancouver Coastal Health will provide publicly funded gender-affirming lower surgeries.

While publicly funded breast augmentation or chest construction surgeries are only currently available in Vancouver and Victoria, the province is expanding access with plans to provide surgical services in five additional cities across B.C.: Burnaby, Kamloops, Kelowna, Port Moody, and Prince George.

How service providers can improve access to gender-affirming care

“One big concrete step is to not turn folks away if they are trans,” says Wilson. He says health practitioners need to understand that care for trans people is not specialized. “It’s important to not leave trans folks without options.”

Another step health care professionals can take is they can work to increase their cultural competency surrounding trans equity. The Trans Care B.C. website is a great place to start. It has a comprehensive compilation of resources, and hosts online learning modules for health care providers. Included in its resources is information surrounding terminology and pronouns. And staff are available to answer questions that might arise. In-person trainings are also available for staff of PHSA.  

Wilson also encourages health professionals to examine their place of work and ask if they are safe, inclusive places for trans people. Are the washrooms safe for trans people to use? Are trans people represented in posters on the wall? Are trans people accounted for in things such as intake forms?

In his advice to trans patients seeking out health services, Wilson says that finding allies is an important piece of the puzzle. “Transition can be a turbulent time for folks.”

“Find providers that you can trust or services that you trust that are affirming,” he suggests. “And reach out for support where you need it, whether that is around transition or counselling, mental health supports, of peer supports.”

“Also know that we are there to support folks and troubleshoot with folks to find the answers to their questions, whether that is around transition, advocating for themselves, or navigating the system.”

To read the December 2018 issue of The Report, click here.