Meeting the health care needs of trans clients

An overview for primary care providers

Transitioning is not a linear, rapid progress from one binary gender to the other. Each client may have a different pathway, journey and end goal in actualizing the expression of their true self. Use the diagram below to familiarize yourself with the various health care needs of trans and gender-diverse clients.

Click on the labels in each step of the diagram in order to learn more

A client-centered, individualized process

Assisting clients in actualizing their gender identity can yield profound improvements in overall wellbeing. The client is at the center of this collaborative process. Trans people are experts on their own experience, listen carefully to their needs and goals.

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Ways to support the inclusion of trans people in your practice/clinic:

  • Provide intake forms that allow for trans patients/clients to self-identify
  • Assume that any patient may be trans
  • Ensure that all providers and staff use pronouns and names appropriate to a client's gender idenitity. It is important to ask the person if you are in doubt.
  • Use posters/signs to indicate a trans-friendly environment.

Source: Bauer, Hammond, Travers, et al. “I don’t think this is theoretical; this is our lives”: How erasure impacts health care for transgender people. JANAC 2009;20(5):348-361.

Transition-related care

Trans people may or may not require access to medical transition-related care. Transition is a process that refers to a host of activities that people may pursue in order to affirm their gender identity. This may or may not include a change of name, pronouns, or physical changes from medication/ hormones or surgery, or a change in clothing, hair style, etc.

Societal roles and personal expressions are becoming more gender fluid. This approach allows for a range of trans identities and treatment options. If your client is ready to initiate their gender transition, but presents in a manner which does not fully conform to societal expectations of masculinity or femininity, this should not impede access to hormonal treatment.

Basic medical care

Keep in mind that not all trans and gender-diverse people experience body discomfort. Your client may just need general medical advice from you.

Long-term preventive care

An essential part of primary care is ongoing follow up with clients:

See long-term preventive care recommendations for trans women
See long-term preventive care recommendations for trans men

Non-medical transition care

Though hormones and/or surgery are medically necessary for many trans people, others may obtain relief of gender dysphoria through other means of modifying their self expression such as changes in legal identification and modifications to their dress, gait, and/or voice.

Psychosocial transitioning

There are various non-medical components of transition that help affirm and realize a person’s gender identity. Having an outer presentation that reflects a person’s own sense of self can profoundly increase a person’s well-being. Examples of expression may include changing the clothes one wears, changing one’s voice, posture, and gait.

Non-medical options available to trans clients:

  • Changes to person's gender expression/role: This could include changes in posture or gait, binding or padding of chest, hips or buttocks, penile tucking or use of prostheses
  • Changes to voice and communication
  • Hair removal

Medical transition care

The health care needs of most trans clients are not medically complex. However many clients will seek medical assistance in order bring their physical appearance in line with their gender identity. This could include hormone therapy and/or surgery/surgeries.

Common primary care services needed by trans clients:

  • Assistance in exploring hormone therapy and surgery options
  • Hormone therapy
  • Referral to surgery
  • Support and guidance

Referral to surgery

Some trans clients may consider surgery.

Since transition-related/gender-confirming surgeries were relisted under OHIP coverage in 2008, surgical referral was relegated to the CAMH Gender Identity Clinic. However in March 2016, the ministry of health and long term care announced a regulatory change that allowed primary care providers (physicians or nurse practitioners) to coordinate surgical referrals. This was a great change that is already increasing access to trans Ontarians, and doing tremendous work to move the conversation of trans health care completely into primary care.

Benefits of surgical referral being coordinated in primary care?

  • depathologizing of gender identity
  • recognition of the relationships that are built in primary care over the lifetime
  • decentralization of access points that can have the most dramatic benefit for remote and rural trans folks with limited access to travel
Learn how to refer a client to surgery

OHIP covered surgeries are:

Masculinizing surgeries
Feminizing surgeries

Hormone therapy

When appropriately prescribed and monitored hormone therapy can profoundly improve the well-being of trans people. Delaying hormone treatment can cause a lot of harm.

Our approach

Although the decision to implement treatment with hormones for a trans client is individualized, there are some common guidelines undertaken by Sherbourne Health Centre. Our approach to the assessment process for hormone therapy shifts the patient-provider dynamic from gatekeeper to “collaborator”. The focus is on informing, educating, guiding and supporting the client in order to support each person throughout their unique transition, while ensuring that they are mentally and emotionally prepared for the particular changes and challenges that transition will bring.

Learn how to assess new/newly transitioning clients for hormone therapy

Management of hormone therapy

The goals of hormone therapy is to alter secondary sex characteristics. Click the links below to learn more on the management of hormone therapy:

Learn how to manage feminizing hormone therapy
Learn how to manage masculinizing hormone therapy

Hormone Initial Assessment

Feminizing Hormone Therapy

Masculinizing Hormone Therapy