N.S. streamlines process for people seeking gender-affirming surgery

Nova Scotians seeking gender-affirming surgery will no longer need to submit three letters from different health-care providers before their request can be considered.

The province announced Wednesday it would eliminate the need for two of three letters, including a letter of support from a specialist and another confirming post-operative care, for people undergoing surgery in Nova Scotia.

Health Minister Michelle Thompson said people hoping for surgery saw the support letter as an unnecessary barrier to their health care.

"We had heard from the community that the need for this additional [specialist] referral caused an extended wait period up to six to 18 months," Thompson said in an interview. "By removing that step, we've increased access, shortened wait times in order for people to get care in a more timely fashion."

The support letter will also no longer be required for Nova Scotians seeking gender-affirming surgery out of province, though they must still provide a note from a physician or nurse practitioner stating they agree to take on followup care.

Specialists not accepting patients

Last spring, people seeking surgery faced growing wait times when two endocrinologists who provided support letters stopped accepting new patients because they felt they had reached their patient limit.

People who want to surgically change their physical appearance to better reflect their gender identity, whether in Nova Scotia or out of province, will still need to undergo a psychosocial assessment and have someone attest to the need for surgery. 

The province said Wednesday that physicians, nurse practitioners and specialists with specific skills in gender-affirming care can now complete the required documentation.

Groups that advocate on behalf of transgender, intersex and gender-diverse Nova Scotians celebrated the announcement Wednesday. 

At the Halifax Sexual Health Centre, phones started ringing off the hook once news of the change started spreading.

"Specialist letter requirement for gender-affirming surgery is where the bulk of the wait happened for folks looking to apply for those procedures," said Abbey Ferguson, the centre's executive director.

"That is a big shift and a big chunk of time taken away from folks who are essentially just sitting and waiting for another checkbox and another signature from a specialist provider."

Riley Nielson-Baker was also happy to hear the process was being streamlined. They are the executive director of Gender Affirming Care Nova Scotia, a group that has been lobbying for this change and many others.

Neilson-Baker said the change would impact thousands of people they've connected with through their advocacy work.

"So many people that I've talked to since this has been released have told me that they feel a sense of elation or stress off their shoulders because they personally will have fewer barriers now," said Neilson-Baker.

According to data released to CBC News by the Health Department, there were 122 Nova Scotians who requested approval for gender-affirming surgery between Feb. 1, 2022, and April 30, 2022. Of those requests, 57 were approved and 65 were deemed incomplete.

Forty-eight people were approved to have their operations performed at a specialized clinic in Montreal. Certain gender-affirming procedures are not offered in Nova Scotia.

Thompson could not say how many people would benefit by streamlining the process.

"What's important is the quality of care for a group of individuals who have consistently talked about having difficulty accessing really important and, in some case, life-saving care for them," she said.