This quick reference guide was derived from Sherbourne Health Center’s Guidelines and Protocols for Hormone Replacement Therapy and Primary Health Care for Trans Clients and is designed to be used in conjunction with the full Protocols.
As a primary care provider it is important to be an advocate for you client and support them to actualizing their gender in all walks of life. Below are resources that help you and your client in navigating systemic barriers in health and legal and policy.
For clients covered by the Ontario Drug Benefit (ODB) program, oral estrogen (Estrace, Premarin) and intramuscular (IM) testosterone are covered with the submission of an Exceptional Access Form (EAP).
Some trans clients may consider surgery.
Since 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.
The referral to the ministry includes either one (in the case of top surgeries) or two (in the case of gonadal and/or genital surgeries) referral letters. The content for the letters are outlined in the prior approval forms. The ministry does not require you to submit any additional information, but expects that you have also documented in practice:
The additional information outlined above may also be necessary to present in the referral to the surgical facility that is performing the surgery.
The following is a compilation of resources for primary care providers as well as suggestions for keeping up to date on topics in the health care of trans clients. Additionally, opportunities for peer discussion and obtaining input regarding specific clinical scenarios are listed.