Guidelines and Protocols
WPATH Standards of Care: https://www.wpath.org/publications/soc
WPATH (World Professional Association for Transgender Health) "has established internationally accepted Standards of Care (SOC) for the treatment of individuals with gender dysphoria. These internationally accepted guidelines are designed to promote the health and welfare of transgender, transsexual and gender variant persons in all cultural settings. The Standards of Care are updated and revised as new scientific information becomes available." The above is a PDF of the latest version (v.7) of these ethical standards.
Sherbourne Health Centre's Guidelines and Protocols for Hormone therapy and Primary Care for Trans Clients (PDF):
https://sherbourne.on.ca/primary-family-health-care/lgbt-health/trans-health-care/
"The WPATH Standards of Care provide an international professional consensus around current knowledge and the role of the clinician in working with trans clients. While it is the ‘gold standard’ consensus, it does not provide specifics around hormone provision or direction around aspects of primary care that merit consideration. Many clinics have developed protocols for their own practitioners, also available to the public, which are more specific in their details around management. Likewise, SHC presents this guideline to summarize the current clinical practice at the Centre."
Basic Information
Terminology https://www.rainbowhealthontario.ca/TransHealthGuide/intro-terms.html
Why is Trans health care important? https://www.rainbowhealthontario.ca/TransHealthGuide/intro-needforcare.html
How health care needs of Trans* patients differ https://www.rainbowhealthontario.ca/TransHealthGuide/intro-transition.html
Transition Information
Guidelines for initial assessments (incl. assessment checklist) https://www.rainbowhealthontario.ca/TransHealthGuide/gp-initialassess.html
Feminizing Hormone Therapy https://www.rainbowhealthontario.ca/TransHealthGuide/gp-femht.html
Masculinizing Hormone Therapy https://www.rainbowhealthontario.ca/TransHealthGuide/gp-mascht.html
Hormone Point-of-Care Guides https://www.rainbowhealthontario.ca/TransHealthGuide/resources.html#refguides
Includes; consent forms; hormone therapy monitoring guides; and hormone therapy effects timelines.
Advocacy for Gender Actualization https://www.rainbowhealthontario.ca/TransHealthGuide/resources.html#advocacy
Includes; guide for changing sex designation on legal documents; writing support letters; Exceptional Access Program (for hormone coverage under ODB); and surgery referrals.
Assessments and letters of referral are required by the WPATH standards of care, which most health care providers have adopted (see link 1); however, some providers use informed consent (see link 2).
Gender Confirming Surgery/Sex Reassignment Surgery
Please refer health care providers to the government web pages first. This should give them the majority of the information they need to make a referral for surgery.
*NOTE: Surgeries MUST be approved by the Ministry of Health and Long Term Care PRIOR to the surgery taking place in order to be covered by OHIP. Please find the application in the VPN outreach file:
SHARED FILES>Resources>Transgender Resources *
The Ministry of Health and Long Term Care http://www.health.gov.on.ca/en/pro/programs/srs/
The Government of Ontario/OHIP https://www.ontario.ca/page/gender-confirming-surgery
There is currently only one clinic in Canada that performs genital sex reassignment surgery (also known as 'bottom surgery'). This is the GRS Montreal. They also perform chest sex reassignment surgery (mastectomies and augmentations, also known as 'top surgeries').
OHIP will pay for accommodations in Montreal for 3 days, as well as transportation to and from the clinic/hotel if you arrived by train or plane.
Contact: https://www.grsmontreal.com/en/home.html
(514) 288-2097
Currently, there are two clinics at which you can access ohip funded top surgery in Canada. One is GRS Montreal, and the other is the McLean Clinic. Hugh McLean has two clinics, one in Toronto, and one in Mississauga.
Contact: https://www.ftmtopsurgery.ca/
(1-855) 311-7722
Other medical clinics are available for top surgery; however, they are not approved to be covered by OHIP. This does not mean that the surgeons at these clinics are not qualified or reputable, but there is a cost associated with having procedures performed at these clinics.
Rainbow Health Ontario
https://www.rainbowhealthontario.ca/training/
"While LGBT2SQ people have many of the same health concerns as the general population, these health needs are affected by a number of issues that are specific to LGBT2SQ communities, and LGBT2SQ people face several barriers to accessing health care. RHO provides training to assist health care and social service providers in their understanding of these issues and to improve their skills in providing equitable and comprehensive services to LGBT2SQ people.
"When it comes to trans and gender-diverse care, primary health care, such as hormone treatment, is not currently a part of the standard medical education curriculum, and many clinicians have never seen (or believe they have never seen) gender-diverse people in their practice. Trans and gender-diverse people are often referred elsewhere, even when their health needs are routine.
"There is currently strong and diverse leadership for gender-diverse folks in communities across the province, that RHO supports through mentorship and networking. However, many regions of the province still lack services, and RHO is working to improve that, in part through training."
Contact: To request training, complete form at bottom of web page.
KW Counselling Services
https://www.kwcounselling.com/counselling/counselling-services-for-2slgbtqia/
"Our staff has a number of professional specialties and respond to community learning needs with customized workshops and seminars. A few of the training opportunities that have been offered include:
The Ins and Outs of Running a Walk In Counselling Clinic
Transgender 101 for Service Providers
Nurturing Queer Youth: Family Therapy Transformed
Understanding and Supporting Transgender Children and Youth"
Contact: (519) 884-0000 x 249
OK2BME
https://ok2bme.ca/services/public-education-training-and-consultation/
"OK2BME offers a variety of public education and training services. Our staff provide interactive and engaging workshops on a host of LGBTQ+ related topics including:
LGBTQ2+ 101
Trans 101
Working with Gender Independent Children and Youth
LGBTQ2+ and Social Justice
Best Practices for GSA Creation and Growth
About OK2BME
LGBTQ2+ Issues in Education
Becoming an LGBTQ2+-Inclusive Agency
Working with LGBQ Youth as a Clinician
Working with Trans Youth as a Clinician
LGBTQ2+ Families
Bill 89, Supporting Children, Youth and Families Act, 2017
Bill C-16, An Act to amend the Canadian Human Rights Act and the Criminal Code"
Contact: OK2BME coordinator Wash Silk wsilk@kwcounselling.com or (519) 884-0000 x 213
Upper Grand Family Health Team
Dr. Lu is trained in trans health care.
**ARCH is not currently accepting new patients, and their waitlist is closed (Dec. 2016)
ARCH Clinic offers hormonal treatment options for those looking for medical support through transitioning. Patients can self-refer or be referred to ARCH by a health care provider. ARCH Clinic operates within an informed consent model meaning that psychiatric evaluations are not necessary for individuals to begin hormonal treatment. Patients begin with a detailed intake appointment with our nurse, where hormonal treatment information is discussed. Patients return after a minimum of two weeks with a signed consent form, to their first appointment with the doctor to discuss their treatment options.
ARCH Clinic offer preventative healthcare that includes annual physicals, immunizations, testing and screening is available. We also offer treatment and monitoring of temporary and chronic health issues for Transgender individuals.
519-763-2255
Sherbourne Health Centre and Rainbow Health
Sherbourne Health Centre is located on the site of the former Central Hospital, which began as an institution to serve the needs of new immigrants to Toronto. Therefore it is fitting that newcomers are one of the key client groups served, along with LGBTQ people and people who are homeless or under-housed.
Since 2007 they have been serving clients through their Family Health Team, which comprises nurses, mental health counsellors, physicians, outreach workers, dietitians, client resource workers, and health promoters.
http://www.rainbowhealthontario.ca/ :
Rainbow Health Ontario works to improve the health and well being of LGBTQ people in Ontario, and to increase access to competent and LGBTQ friendly health care services across the province. We do this by providing education and training to providers, advocating for public policy change, sharing information and consulting with service providers and organizations.
Rainbow Health Ontario is a province wide program developed and maintained by Sherbourne Health Centre.
CAMH Gender Identity Clinic
Contact:
https://www.camh.ca/en/your-care/programs-and-services/gender-identity-clinic-adult
The CAMH GI Clinic is intended for individuals over 18 who wish to explore issues related to their gender identity, which may include any degree of transgender expression, and community professionals looking for support and consultation to help their clients reach their goals related to gender identity and expression.
The wait list is currently 8-9 months according to their website.
A referral from a physician is required to access services, and can be found here: https://www.camh.ca/-/media/files/camh_referral_form-pdf.pdf?la=en&hash=45E3B437F390593BDD6C01018A150DE7A86998AE
When completed, the referral can be faxed to : Access CAMH at (416) 979-6815
GRS Montreal
Surgeons:
Dr. Brassard: https://www.grsmontreal.com/en/surgeons/1-dr-pierre-brassard.html
Dr. Belanger: https://www.grsmontreal.com/en/surgeons/2-dre-maud-belanger.html
Dr. Brousseau : https://www.grsmontreal.com/en/surgeons/5-dre-valerie-j-brousseau.html
Dr. Laungani : https://www.grsmontreal.com/en/surgeons/4-dr-alex-laungani.html
Dr. Lee : https://www.grsmontreal.com/en/surgeons/6-dr-chen-lee.html
KW Counselling / OK2BME
OK2BME (Waterloo Region) offers free counselling to trans and/or gender questioning people aged 5-29 . They can do this in office, and via video call. They also offer free family therapy for families and parents trying to navigate their child (under 18) coming out and/or transitioning.
Trans Lifeline
https://www.translifeline.org/
Crisis hotline: 877-330-6366
Trans Lifeline is a national trans-led 501(c)(3) organization dedicated to improving the quality of trans lives by responding to the critical needs of the community with direct service, material support, advocacy, and education. Their vision is to fight the epidemic of trans suicide and improve overall life-outcomes of trans people by facilitating justice-oriented, collective community aid.
Further reading