Family doctors a critical piece of transition health care, trans advocates say

Sadie von Scarlett began her medical transition in Kingston, Ont., but earlier this year moved to Ottawa in search of a more supportive community.

She says she found that community, but lost an important support when she left her family doctor behind. 

Von Scarlett planned months in advance for her move and was able to transfer to the Centretown Community Health Centre's (CCHC) trans health clinic for her hormone replacement therapy, but has yet to find a primary care physician. 

Trans advocates say family doctors have a crucial role to play in a patient's transition because they can help connect them to the services they'll need throughout the process. 

The clinic is helpful, but von Scarlett says her health-care needs extend beyond it. 

"They can deal with some things, but they're not set up like a family health clinic is and they can't prescribe things like certain antidepressants … so there's a huge lack of care," von Scarlett said. 

Lack of doctors a challenge

Michelle Hurtubise, the health centre's executive director, says the clinic is designed to work in concert with a family doctor. 

It helps people start the transition process and can make referrals for gender affirming surgery, but after that, Hurtubise said, their care is usually handed over.  

"Now the challenge is a number of people do not have a primary care provider," Hurtubise said. "We may continue to see them for their hormone replacement therapies, but we're also not providing that comprehensive full primary care." 

It's one of the only clinics providing trans health care to adults in the city, and as a result people are waiting more than two years for an appointment, Hurtubise said.

The number of referrals to the clinic has doubled every year since 2018. 

'A lot of hurdles'

Fae Johnstone, an LGBTQ rights advocate and executive director of the consulting firm Wisdom2Action, said von Scarlett's experience is common. 

"There's a lot of hurdles, but one of the first ones is often finding a primary care provider who's able to help you with your transition," Johnstone said.

While there's already a general shortage of family doctors, she said the pool is even smaller for those who are transitioning because a lot of doctors don't have trans inclusion training. 

"Folks are often stuck from that first step, and that's why they often head to gender clinics like the Trans Health program at Centretown Community Health Centre."

Jaime Sadgrove, the manager of communications at the Canadian Centre for Gender and Sexual Diversity, agrees.

"You're kind of playing the roulette of going to walk in clinics and hoping that you get a doctor who is competent in trans health care, who kind of understands what their role is."

But they said finding one is key. Sadgrove says family doctors can connect patients to the array of care they need during the transition process. 

"If you have a heart condition and you go see a cardiologist for your heart condition, they're not going to be able to replace your primary care physician for all your other medical needs, right? They're there to do a specific job and the trans health clinic kind of functions very similarly," they said.

'Don't call me dude'

During von Scarlett's transition, she needed access to mental health care. 

She said while her experience in Ottawa has been largely positive, she has been the subject of microaggressions at work— von Scarlett is an electrician — where she said she's constantly misgendered. 

"Some people do it and I just correct them and say please don't say that anymore, I'm a girl. Don't call me dude, man, guy, buddy, fella or anything like that. And they'll still do it. That's a challenge, day to day," she said.

Von Scarlett goes for counselling sessions at the CCHC, but they are limited in scope. She said the mental health coverage under OHIP is also limited, but when she tried going to private therapy a few years ago, she had to work two jobs to be able to afford it. 

"You kind of feel like you're taking two steps forward and one step back all the time because you need to take time for yourself. You can't work seven days a week," she said.

Sadgrove say an integrated trans health hub could function like a family doctor on a larger scale, connecting trans people with the health-care services they need in a welcoming environment. Sadgrove said Ottawa could take their cues from The519 in Toronto. 

They said the city should also set up a liaison who can be in touch with the trans community in Ottawa about their needs.

Ottawa Public Health told CBC in an email it wants to see an increase in access to mental health services and gender-affirming care.