Advocates draft policy aimed at changing gender-affirming care in Nova Scotia

Some advocates in Nova Scotia say the province needs better gender-affirming care, so they've drafted their own community-based policy and hope to see it adopted by the Department of Health and Wellness.

"The priority being that this is community-based policy," said Riley Nielson-Baker, a trans activist and part of the two-person Gender Affirming Care Policy Team looking to change how people receive gender-affirming treatment.

"People who are in a specific community know where the system is failing them and how it's failing them."

Gender affirming care (GAC) covers a wide range of procedures and treatments, from hair removal to hormone therapy, and can be defined as health care that helps align one's body and physical presentation with one's gender identity.

The policy's primary goal is to reduce the amount of referral letters needed in order to be approved for gender-affirming procedures, one of the primary flaws with the current policy, according to Nielson-Baker, who is public servant and has a background in policymaking.

"Now imagine you are any other person trying to access a life-saving surgery or life-saving procedures, you wouldn't have to go out and get to psychology, a psychiatrist, a psychologist, and then the surgeon to approve you for life-saving care."

Wide consultations

Nielson-Baker, who is non-binary, started drafting the first copy of the policy in February of last year and has since joined forces with Carson Cameron, a second-year science student at Mount Saint Vincent University.

Together, they've consulted dozens of people in Nova Scotia and across Canada, getting their thoughts on how current gender-affirming care in the province could be improved.

They hope the policy will soon be implemented by the province.

"More than 100 people have touched this at some point, all parts of Nova Scotia and Canada, and we've had some international consults too," said Cameron, who is also currently investigating the chemical compounds used in hormone replacement therapy and their physiological effects. 

Cameron said they hope to eventually integrate the research on hormones into clinical practice, creating safer spaces in health care for people seeking gender-affirming care.

They're also looking for more staff to be added to prideHealth, a division within the province's health authority that works to improve access to safe and culturally appropriate health services for members of the 2SLGBTQIA+ community, as well as add family doctors and nurse practitioners to the list of those able to assess the needs of people seeking gender-affirming care.

Nielson-Baker said the current way of doing things ties up doctors and psychiatrists, adding more people to already months-long wait-lists.

Covering procedures

Right now, in Nova Scotia people are able to get what is commonly called top-and-bottom surgery — such as breast augmentation or mastectomy, and testicle or ovary removal — covered by the province. Hormone replacement therapy is not covered by the province, but is covered by most health insurance plans.

However, there are other sometimes integral surgeries and procedures Nielson-Baker said need to be added to existing health-care coverage, such as hair removal and shaving the Adam's apple.

"For trans-feminine people, we're talking about the removal of hair, say at the beard line, that no matter what you do will not go away and can be both a sense of dysphoria, and also a potential risk factor for passing if they want to."

The Gender Affirming Care Policy Team has garnered 42 supporters, including the Canadian Mental Health Association, Nova Scotia Nurses' Union and the Nova Scotia Federation of Labour.

Doctors Nova Scotia, the professional association representing physicians in the province, has said it endorses the new policy and supports improved access to gender-affirming surgeries.

"The policy is a comprehensive overview of approaches and supports needed in N.S. health care to ensure that gender-affirming care is the default in the province," Dr. Heather Johnson, president of Doctors Nova Scotia, told CBC News in an email.

"Physicians who have reviewed the policy hope that it will be a living document which is updated as new information and new opportunities for system improvement arise, such as patient safety across all health service providers and health system resourcing to support GAC."

Lobbying government

Cameron said they plan to seek even more support this summer before lobbying government officials, however they're growing more optimistic the new policy will be accepted.

"We are thankful for our policy's traction provincially and nationally," said Cameron. 

"Progress has been swift, particularly within the past few weeks, as giants in the Pride community have embraced us. Gender-affirming care will change drastically under our well-studied policy."

Marla MacInnis, a spokesperson for the Department of Health and Wellness, said the government is committed to improving access and the experience of those seeking gender-affirming care.

"We have received a copy of this policy and are reviewing it closely," she told CBC via email.