The Trans Health Program offers hormone therapy starts and surgery referral support to trans and non-binary people, ages 17 and up from Ottawa and surrounding areas. We tailor our services to the needs and transition goals of our clients. For example, some of our clients seek maximum feminization/ masculinization, while others seek a more androgynous appearance.

Our service model follows the Sherbourne Guidelines for Gender-Affirming Primary Care with Trans and Non-Binary Patients.[1] Our services are continuously evolving, as we learn from our clients and other experts.

Informed consent

The Trans Health Program services are a collaborative process that focuses on both psychosocial preparation and informed consent. It is the provider’s responsibility to make sure you know what to expect from hormone therapy including physical and emotional changes, side effects and potential risks. The provider will guide you in this discussion by asking you about your health and transition goals. They will then ensure you have all the information you need to make the right choice for you.

Intake

During your intake appointment with the Community Support Worker (CSW), you will learn about our services in more detail. The CSW will ask you about your transition goals in order to connect you to the right services and to provide information about what to expect from hormone therapy and/or surgeries. They will also ask you if there are any health or other concerns you would like the provider to know before your first appointment and connect you with any supports you may wish to access (ex. counselling, community resources). The CSW will be able to give you a sense of the wait time before your first clinical appointment and discuss other options.

The CSW will also ask you if you have a family doctor. If you have a family doctor, the two of you will work together to plan how to communicate to them about your transition. The clinic will never share information about your care without your permission. 

Hormone starts

Below we describe the typical process through the clinic for people who seek feminizing and masculinizing hormones. Keep in mind that your journey may vary depending on your transition goals and needs.

Visit 1

At the start of your first clinical visit, you will be welcomed by the Community Support Worker. Afterwards, you will meet with a registered nurse and with your provider (a medical doctor or nurse practitioner). Throughout this first appointment, you will be asked a lot of questions. Remember that there are no right or wrong answers.

The nurse will take your vitals (blood pressure, height and weight) and gather your medical history, including your immunization record.  

Your provider (medical doctor or nurse practitioner) will ask you open-ended questions about your gender identity and expression. For example, “How would you describe your gender?” “How do you see transition affecting your relationships?” During this conversation, they will get information about the supports and people in your life, your transition goals, and how you think your transition might affect your relationships, school/work, and housing.

Your provider will then review some of the risks associated with hormones. During this conversation, they will ask you about your health. There are very few absolute contradictions to prescribing hormones. Examples include a deadly allergy to the medication and end-stage liver failure. Depending on your health status, there could also be relative contraindications, which would increase your risk for health complications. In these cases, your provider will discuss risk management strategies with you.

During your first visit, your provider will give you a bloodwork requisition form (see below for more details about bloodwork). You will need to get the bloodwork done before your second visit.

Visit 2

The second visit generally takes place one week after the first visit. You will once again meet with a registered nurse and your provider. The nurse will take your vitals. The provider will go over your bloodwork.

If you are interested in feminizing hormones: With your permission, the provider may also proceed to a targeted exam. They may ask to measure your chest circumference to establish a baseline with which to track growth. They might suggest a liver exam and a circulation exam of the lower extremities as estrogen can affect the liver and increase the risk of blood clots. The provider may also offer to do a testicular exam (if applicable) to check for cancer.

Assuming there are no further health conditions to explore, you provider will then go over your androgen blocker options, their potential side effects and benefits. You can decide which option is best for you.

If you are interested in masculinizing hormones: After going over your bloodwork, and assuming there are no further medical issues to investigate, the provider will go over in details the effects of testosterone before providing you with a prescription.

Visit 3

If you are interested in feminizing hormones: This visit generally takes place 4-6 weeks after the second visit. In your third visit, you will discuss the progress of the androgen blocker. If everything is going well, you will be prescribed estrogen.

If you are interested in masculinizing hormones: This visit generally takes place 6 weeks after the second. The team will monitor your progress and make adjustment as necessary.

Visits 4 & 5 (if needed)

The team will continue to monitor your progress and make adjustments as necessary. Once you have reached maintenance hormone doses, the clinic will discharge you back to your primary care provider or another provider who will be able to continue your care.

Bloodwork

Bloodwork is important in order to create a baseline your provider can use to monitor change over time. It also screens for health issue which could affect how your body reacts to an androgen blocker and/or hormones.

What is being measuredRelevant forHow it is written on the requisition formWhy we check
Sugar and cholesterolFeminizing and masculinizing hormonesGlucose, Lipid AssessmentDepending on your sex hormones, your body will process sugar and cholesterol differently. This measure creates a baseline
Liver functionFeminizing and masculinizing hormonesALT, Immune status for Hepatitis A, B, and C.Drugs can irritate the liver; these tests create a baseline and check for signs of an irritated liver.
Complete blood countFeminizing and masculinizing hormonesCBCTestosterone and estrogen impact the hemoglobin and hematocrit in your blood. This test creates a baseline.
Kidney functionFeminizing hormonesCreatinine, Sodium, PotassiumAn androgen blocker may affect the kidney; this test creates a baseline
Hormone levelsFeminizing and masculinizing hormonesTestosterone, Luteinizing hormone, EstradiolCreates a baseline and check for hormonal issues.
Hormone levelsFeminizing hormonesProlactinCreates a baseline to monitor potential effects of the blocker

Medications and their side effects

You can find more information about the types of medication prescribed, their effects, side effects, and costs by consulting the online version of the Sherbourne Guidelines 

Feminizing Hormone Therapy:
https://www.rainbowhealthontario.ca/TransHealthGuide/gp-femht.html

Masculinizing Hormone Therapy:
https://www.rainbowhealthontario.ca/TransHealthGuide/gp-mascht.html

Surgery Referral Support

Our surgery support services include giving information about what surgeries are available, assisting with getting OHIP funding pre-approval, doing surgery assessment letters for surgeons, and helping clients develop a plan for your surgery and aftercare.

Information

Our team will explain to you your surgery options including information about which surgeries are funded by OHIP and which surgeons perform these surgeries.

OHIP surgery funding pre-approval & surgery assessment letters for the surgeon

In order to access OHIP funded surgeries, you will need a Prior Approval Funding Form which includes 1 or 2 supporting assessments. The number of assessments depends on the type of surgery. Upper surgery (specifically chest) requires 1 supporting assessment from a qualified doctor or nurse practitioner. Lower surgery (genital surgery) requires 2 supporting assessments. One assessment from a qualified physician or nurse practitioner and a second assessment from a qualified physician, nurse practitioner, registered nurse, psychologist or registered social worker with a Masters degree.

For more information, consult the transition-related surgery (trs)* frequently asked questions (https://www.rainbowhealthontario.ca/resources/transition-related-surgery-trs-frequently-asked-questions/)

Surgery assessment process

Depending on the required assessment letter(s) you will meet with one of our providers (doctor or nurse practitioner) and/or one of our counsellors. They will ask you questions about your gender history, including questions about your desires and expectations related to surgeries. They will also ask you questions about your social and medical history, including your physical and mental health as well as whether you have had any previous surgeries. If you are new to the clinic, you may also have a visit with the nurse who will take your medical history before your surgical assessment appointment.

Developing a plan for surgery and support for surgery aftercare

Our team will support you in making a plan for your surgery and aftercare. You will need housing that is safe, clean, and stable in order to recover. While you heal, you will have physical and functional limitations and may require support. You will need to plan for time off work and the financial cost of travel, medications, and supplies. You will also need post-operation aftercare to ensure that you are recovering well.


[1] You can access the Guidelines online : https://www.rainbowhealthontario.ca/product/4th-edition-sherbournes-guidelines-for-gender-affirming-primary-care-with-trans-and-non-binary-patients/