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guide to assist clinicians who are or may be taking on similar work. The toolkit does not represent an exhaustive review of the medical literature, although many research articles and other protocols have been reviewed to inform the medical aspects of care. Trans Care BC assumes no responsibility or liability for any harm, damage or other losses, direct or indirect, resulting from reliance on the use or the misuse of any information contained in this toolkit. Trans Care BC Primary Care Toolkit Introduction 1 Introduction Transgender people are an underserved population who continue to face societal stigma and discrimination in many areas including health care settings. They are disproportionately affected by poverty, homelessness, unemployment, and health problems such as depression, substance use disorders, and HIV. As primary care providers, nurse practitioners (NPs) and family physicians (GPs) are uniquely well positioned to address these health disparities and increase access to gender-affirming health care. Historically, transgender care was provided in highly specialized gender clinics, but in the last decade there has been a shift toward distributed care models. In Canada and the US, there is increasing recognition that trans people can be well-served in primary care settings and that with some additional training, GPs and NPs can provide many aspects of gender-affirming care. Trans people have the right to respectful, dignified, gender-affirming health care in their home communities, and enhancing your skills and providing gender-affirming care in your practice can have a profound impact on the health of trans people in your community. This Primary Care Toolkit is intended to support GPs and NPs who are relatively new to providing care to gender diverse people. It includes some basic information about gender-affirming care options and tools to assist with initiating and/or maintaining hormone therapy. It also directs you to further reading and provides suggestions for where you can access support from more experienced clinicians. This toolkit has been informed by the collective clinical expertise of the members of our Primary Care Working Group and by existing guidelines from Canada and the US. Our website (www.transcarebc.ca) lists comprehensive resources as they become available, including foundational and CME-accredited online training modules. For care providers and staff who are new to working with gender diverse clients, we recommend the online training module Exploring Gender Diversity. The content in this toolkit has been created with an adult patient population in mind and it should be noted that assessment and treatment of gender dysphoria for youth requires appropriate training, family engagement (whenever possible) and awareness of developmental and mental well-being considerations. While some youth are safely served in a primary care setting, others require specialist support and care. Trans Care BC is working with BC Children’s Hospital and other stakeholders to improve access to care and support for gender creative and trans youth, children and their families. Future training opportunities, clinical resources and tools will be available to support clinicians engaged in this work. For resources and information about care for trans young people and families, see the BC Children’s Hospital Endocrine Clinic www.bcchildrens.ca/our-services/clinics/gender and Trans Care BC website www.transcarebc.ca. 2 Gender-affirming health care options Trans Care BC Primary Care Toolkit Gender-affirming health care options Gender-affirming health care must be individualized according to a patient’s goals and can involve many different aspects of social, medical, and surgical care. The care we provide is intended to relieve gender dysphoria. This has many benefits, including improved mental and physical health and improved social and occupational function. Gender dysphoria refers to discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics) WPATH SOC v7 Discomfort related to gender may present at any age. Medical care, offered in a staged approach, may be appropriate for some individuals following the onset of puberty. Primary care providers are encouraged to to work collaboratively with more advanced practice clinicians when caring for trans youth, especially when new to this area of practice. Please see the section on working with trans youth for more information about caring for younger patients. Primary care providers have an important role to play in discussing gender identity and gender health goals with patients and providing gender-affirming care or referrals for gender-affirming care. The options outlined in this guide are appropriate for individuals with binary (identifying as male or female) and non-binary identities (identifying as a blend of male and female or identifying as neither male nor female), and individuals may require some, all, or none of these options. Social options Some trans people look to their primary care providers for support with non-medical and non-surgical aspects of gender affirmation. Some examples include assisting patients with name and identity changes (see www.transcarebc.ca for
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