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more info), education about safer chest-binding or genital tucking, or counselling about common concerns such as coming out to friends and family or coping with transphobia. Medical options Medical care may involve the use of a progesterone-releasing IUD or medroxyprogesterone (Depo-Provera®) for suppression of monthly bleeding, leuprorelin (Lupron®) for puberty suppression, electrolysis for hair removal or hormone therapy. Surgical options Surgical care may include chest or breast surgery, gonadectomy, genital reconstruction, and a range of other procedures, including tracheal shave and facial surgery. Visit the surgery page at www.transcarebc.ca for information on: ● gender-affirming surgeries ● how to refer a patient for gender-affirming surgery ● health navigation guides to help patients access and prepare for surgery Trans Care BC Primary Care Toolkit Role of the primary care provider: 3 Role of the primary care provider: ➤ Provide an inclusive clinical environment where patients will feel safe talking about their gender ● Resource: Creating Accessible Environments for Gender Diverse People: An Organizational Assessment Tool for Health Care and Support Services: www.transcarebc.ca/health-professionals/education/trans-intro ➤ Respect your patient’s right to self-determine their gender identity ➤ Maintain a gender-affirming approach, including using chosen names and pronouns when interacting with, on behalf of, or when charting on your patient ➤ Be prepared to discuss gender and the range of gender-affirming health care options available ➤ Discuss current supports and plans for navigating transition in relationships, work or school settings and offer support and resources ➤ Assist patients to change their name and identification documents if desired (see www.transcarebc.ca for more info) ➤ Be prepared to work with families, partners and significant others to nurture and sustain supportive relationships, especially when working with youth ➤ Work to stabilize any physical or mental health conditions to ensure they do not pose barriers to the patient accessing gender-affirming interventions such as hormones or surgery ➤ Seek to restore or build capacity where it is diminished to ensure it does not pose a barrier to patient’s ability to provide informed consent ➤ For patients seeking hormone therapy: ● Assess for readiness to begin hormone therapy or refer to someone who will ● Initiate hormone therapy or refer to someone who will ● Provide monitoring related to hormone therapy as needed ➤ For patients seeking surgical interventions: ● Be familiar with the WPATH criteria for surgical intervention(s) ● Complete a surgical readiness assessment if you are qualified, or refer to someone who can ● Refer for surgery, provide post-op care and/or liaise with surgeons as needed Help is available for primary care providers who would like to support a trans patient with gender-affirming care but are unsure how to help – to access the Rapid Access to Consultative Expertise (RACE) Line, please call 604-696-2131 or toll free at 1-877-696-2131 and request the Transgender Health option. 4 Hormone readiness assessment Trans Care BC Primary Care Toolkit Hormone readiness assessment Primary care providers are well positioned to assess readiness for hormone therapy. While there is no waiting period required prior to initiating hormone therapy, there are a number of preparatory steps needed to ensure treatment is indicated and provided in the safest manner possible. Assessment by a psychologist or psychiatrist is not required for most people, however the primary care provider should assess both mental and physical health as part of hormone readiness assessment and refer to appropriate specialists as needed. Assessment often takes place over a number of visits depending on the length of time available per visit, the clinical situation and the experience of the clinician. Please refer to Appendix A for sample questions that you can use to explore gender identity and gender-affirming goals with your clients. More visits may be required for clients with complex physical or mental health issues, or for clients who are socially isolated. Fewer visits may be appropriate for a straightforward patient, for more experienced clinicians, or if appointments are longer. Fewer visits may also be indicated in situations where harm reduction is the priority. The purpose of these visits is to ensure your patient is ready from a medical and psychosocial perspective to begin hormone therapy. This is ideally done within a primary care setting using a gender-affirming, informed consent based approach. The checklist on the next page covers the important considerations and steps to take when getting ready to initiate hormone therapy It is important to review risks, benefits and potential side effects with patients prior to initiating treatment. Sample consent forms are included in this package – see Appendix B for the Testosterone Consent form. Risk considerations: Contraindications to testosterone therapy may include unstable cardiovascular disease, pregnancy or chest/breast feeding, unstable psychosis or mania, active hormone-sensitive cancer and allergy. Many patients choose to begin or continue hormone therapy in spite of contraindications or higher risks. In such cases, care providers should do a careful informed consent process that takes
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