More often than not, members of the Community are unable to access healthcare that recognizes and respects their identities, let alone understands their medical needs. We need to ensure a healthcare system that is able to treat ALL people. Education for upcoming healthcare practioners needs to have 2SLGBTQIA+ healthcare engrained in all courses, along with BIPoC and Disability care. Current healthcare practioners must be encouraged, if not required, to obtain training on all aspects of healthcare freely through the Province to ensure full health equity for the Community. 

We are happy to announce that the recent change to the Department of Health and Wellness's GAS policy now eliminates the requirement of a specialist letter, and only requires a referral letter from a qualified assessor and a letter confirming surgical aftercare for those receiving surgery outside of Nova Scotia!

There is still more to do on this issue. Gatekeeping remains common, and many community members in rural areas continue to experience increased costs to access care.

Very few procedures and services are covered by MSI under the current GAC policy; frequently, those who require GAC cannot get everything they need to live their best life, and even existing options do not address some basic needs, such as breast augmentation. We have expanded the procedures covered by MSI to ensure that more options are available to more people, ensuring everyone can get the care that they need to live their best life. 

The requirement for an individual to have completed any medical transition to obtain legal transition creates an environment in which people are unable to obtain legal documentation and protection at the start of their transition and often forces people to access care they do not need or want. By eliminating all connection between legal and medical transition, we can ensure that all identities are respected and not one is forced into care they do not need.

While healthcare protections for the Community exist, we wanted to strengthen them. All healthcare providers cannot deny access to treatment based on their membership in the Community, they cannot refuse a patient because of their membership in the community, and while an individual healthcare provider can refuse to serve as an assessor for GAC or prescribe HRT, they must provide their patients with an alternative healthcare provider who will. 

Additionally, we have ensured that individuals have the right to their gender and the acknowledgement therein; refusal to and/or continuous lack of acknowledgement of an individual’s name, gender, and pronouns is discriminatory under this policy.

Current systems of GAC revolve around the assumption that individuals must prove that GAC is medically necessary for them. Standard practices under this policy would shift to assume that GAC is medically necessary, and the role of qualified assessors will focus on ensuring that an individual requiring gender affirming services understands the risks of the procedures they are requesting and is of sound mind to make decisions surrounding their gender affirming care.

GAC is not cosmetic, it is life-saving, and must be treated as such to ensure the best possible outcome for as many Community members as possible.

An individual possesses the most comprehensive picture of their gender and their gender affirming care needs; as such, an individual should be guiding their own gender affirming care requirements, with qualified assessors determining their readiness for procedures and services. This policy ensures that the individual seeking GAC is the one directing their care and what procedures they receive under the guidance of their assessor.

In several provinces, including British Columbia, many primary care physicians and nurse practitioners may become qualified assessors for many gender affirming procedures. Physicians, nurse practitioners, and family doctors may be qualified assessors, and education and certification of these professions should be expanded to include competency in assessing their own patients’ requirements for gender affirming services. 

All individuals who would like to become a qualified assessor must complete the necessary training as determined by prideHealth for the relevant professional field or position.

Gender affirming services and procedures shall be provided based on the needs of the individual requiring them, and, unless otherwise noted, will not have the prerequisite of other gender affirming services and procedures. Not every individual is able to, or requires, all procedures available to them to achieve their desired gender presentation, and the limitations of an individual’s health and medical history, as well as the changes they require for their own gender affirming care, should guide which procedures they receive. 

Those with complex care needs requiring gender affirming care will have their gender affirming care related costs covered by MSI, even if their needs require that they utilize a private health practitioner, to ensure that their individual care needs are fully considered while they access gender affirming care. 

prideHealth provides members of the 2SLGBTQIA+ community with support and tools to navigate the Nova Scotia health system; 10-15% of the population of Nova Scotia can access prideHealth. This organization, though, is severely underfunded and understaffed. prideHealth currently operates with two part-time positions for the entire province. This is a form of systemic discrimination, as two part-time staff are supposed to provide support to 10-15% of Nova Scotians, on top as providing education and support to members of the healthcare system on 2SLGBTQIA+ issues. 

This policy will expand prideHealth by providing it the staff that it requires to execute its mandate. The organization will gain five (5) full-time staff, including a Health Equity Consultant, an Education Officer,  a Policy Officer, a Health System Navigator, and an Administrative Assistant, as well as four (4) part-time positions which will oversee regional operations and support members of the community closer to their homes. All of these positions will be designated for members of the 2SLGBTQIA+ community to ensure that members of the community are receiving support from those who understand their needs best. 

Many seniors who require GAC are denied care either because of their age, being seen by their caregiver(s) as no longer needing GAC, or because they did not feel safe coming out until later in life and are seen as "never showing signs of being transgender." These narratives create an environment which denies lifesaving care to individuals based on their age, which is discriminatory.  

Seniors are not automatically denied gender affirming care and procedures by virtue of having a decision maker in place; seniors requiring gendering affirming care will not be denied care for a non-medical reason, and a decision makers’ disagreement with the individual’s need for care shall not serve as a denial of care for the individual. The opinions of the individual’s assessor will be weighed in the context of the needs of the individual and current published evidence relating to risk of non-intervention, and provided at their discretion. 

Frequent ableist narratives state that individuals with disabilities, especially those who are neurodivergent, are unable to make decisions about their gender affirming care needs. This narrative is false and harmful to a population which is already marginalized. 

People with disabilities are not automatically denied gender affirming care and procedures by virtue of having a decision maker in place; people with disabilities requiring gendering affirming care will not be denied care for a non-medical reason, and a decision makers’ disagreement with the individual’s need for care shall not serve as a denial of care for the individual. The opinions of the individual’s assessor will be weighed in the context of the needs of the individual and current published evidence relating to risk of non-intervention, and provided at their discretion. 

Gender affirming care will not be denied to minors based on the fact that they are minors. Pre-puberty is the most important time for intervention for trans people, and by ensuring that early intervention may be made in the form of hormone/puberty blockers, the irreversible changes made through puberty may be avoided, allowing minors to live as their desired gender free from the changes of puberty and easing transition later in life if they so choose. 

Minors are not automatically denied gender affirming care and procedures by virtue of having a decision maker in place; minors requiring gendering affirming care will not be denied care for a non-medical reason, and a decision makers’ disagreement with the minor’s need for care shall not serve as a denial of care for the minor. The opinions of the minor’s assessor will be weighed in the context of the needs of the minor and current published evidence relating to risk of non-intervention, and provided at their discretion. 

No treatment or intervention shall be made on babies and minors based on sex characteristics which vary from typical definitions of male and/or female. Variation in humans, causing variation in an individual’s primary and secondary sex characteristics that do not align with typical definitions of male and/or female, are naturally occurring, and intervening to create a more typical male or female appearance is unnecessary on the basis of improving the health of the child according to medical experts. 

Babies and minors are unable to provide consent for these procedures, and a physician, surgeon, or other health practitioner shall not perform any surgeries altering variations in an individual’s primary and secondary sex characteristics without the informed consent of the minor unless medically necessary. Physicians, surgeons, and/or other health practitioners who perform non-consensual medical interventions on the basis of variations in an individual’s primary and secondary sex characteristics shall be reprimanded by the College of Physicians and Surgeons of Nova Scotia under their current complaints and investigations processes