Point-of-Care Guides

Quick Reference Guide for Primary Care Providers

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.

Quick Reference Guide: Protocols for Hormone Therapy for Trans Clients

Hormone Monitoring Summaries

  • Feminizing Hormone Monitoring Summary
  • Masculinizing Hormone Monitoring Summary

Effects and Expected Time Course of Hormone Therapy Regimens

  • Effects and expected time course of feminizing hormone therapy
  • Effects and expected time course of masculinizing hormone therapy

Consent forms

  • Consent form for feminizing hormone therapy
  • Consent form for masculinizing hormone therapy

Referrals & Advocacy

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.

Changing sex designation

  • Template Letter in Support of an Application For Change of Sex Designation on an Ontario Birth Registration
  • Template Letter in Support of an Application For Change of Sex Designation on an Ontario Driver’s License

Support Letters

Sample Support Letter for Trans Clients Applying for EI through the Just Cause Mechanism

Exceptional Access Program (EAP) for clients on Ontario Drug Benefit (ODB)

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).

  • Sample Request for an Unlisted Drug Product: Oral Estradiol
  • Sample Request for an Unlisted Drug Product: IM Testosterone

Referral to Surgery

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.

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

Two-step referral process:

Request for Prior Approval for Funding of Sex-Reassignment Surgery

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:

  • your training and/or experience in the area of "gender dysphoria and trans/gender-diverse health
  • your process with the client to ensure that they have consented to treatment and, by their and your account, meet the criteria for eligibility according to WPATH (diagnosis of gender dysphoria, can consent to treatment, significant medical/mental health conditions "reasonably well controlled", and for some surgeries, having been on hormones continuously for one year)
  • how long you have been seeing the client
  • some relevant gender history and context around transition
  • any medical or mental health information that would benefit the client and surgeon to know to optimize supports for the client
  • information about smoking and any substance use that would interfere with surgery and recovery
  • risks and benefits of surgery broadly discussed
  • expectations around surgical outcomes, healing, and post-op care discussed
  • your recommendation for surgery

The additional information outlined above may also be necessary to present in the referral to the surgical facility that is performing the surgery.

OHIP covered surgeries are:

Masculinizing surgeries
Feminizing surgeries