Barriers to care persist as Winnipeg gender transition clinics hope to chip away at backlogs
Average wait for gender-affirming care between 1½ and 2 years at pair of Winnipeg clinics
WARNING: This story contains discussion of suicide.
Elisha Dacey's 15-year-old is caught in a care gap: too old to be accepted at one gender transition Winnipeg clinic, too young to get in at another.
"They were right in that sweet spot of technically not getting or qualifying for any kind of public health, so that was frustrating and demoralizing," said Dacey. "Since then we've still been just waiting."
The Gender Diversity Affirmation and Action for Youth clinic (GDAAY) helps children and young teens transition.
It used to help patients up to the age of 15, but has reduced the age referral criteria by one year to 14.
That was in response to demand outpacing resources "owing to the fact that we are entirely unfunded," reads a GDAAY doctor's letter to Dacey's child's pediatrician in April of this year.
The Trans Health Klinic, the only other program in the city, helps people 16 and up transition. Dacey was recently informed their child is now on that waitlist.
They join the roughly 600 other youth and adults who remain in waitlist limbo amid a shortage of care providers outside the two clinics trained in gender-affirming care.
"That's a huge barrier unto itself is just the lack of professionals who are dealing specially in this," said Dacey.
Years-old waitlist challenge
The clinics offer a range of services, from counselling and mental health care to hormone replacement therapy and gender-affirming surgeries.
Intake is a multi-level process and the entire process can span years.
Many patients come from referrals from family doctors and each clinic has struggled to keep pace with demand.
- Have you encountered barriers to transition services outside the clinic programs? Email bryce.hoye@cbc.ca
The annual number of consultations has tripled at GDAAY. Nearly two dozen youth sought consultations the year GDAAY opened in 2011, and that number has increased to about 75 per year, according to a statement from Shared Health, the entity overseeing the delivery of health care in Manitoba.
Shared Health attributes that to increased awareness about transgender issues, a rise in gay-straight alliances and a focus on reduced bullying in schools.
WATCH | Gender transition clinics hope to chip away at backlogs as barriers persist:
Currently, there are nearly 300 youth on the GDAAY waitlist and it's an average two-year wait. It's a similar number of patients on the Trans Health Klinic waitlist, which averages a 1½-year wait.
Dr. Brandy Wicklow, the medical lead of GDAAY, co-authored a scientific paper in 2018 based on work with child patients at GDAAY that suggested trans youth seeking services faced distress "over long wait times."
Spring funding boon to programs
In May, the province committed $1.2 million over two years to help the two clinics improve access to care for transitioning youth, including hormone replacement therapy medication, psychological supports and surgeries.
Staff with each program were encouraged to hear the news.
"It's been challenging to work in this system knowing that the waitlist is as long as it is," said Dr. Megan Cooney, a pediatrician and adolescent medicine specialist with Shared Health who has worked with GDAAY for five years.
"What we're most looking forward to with the program expansion is actually being able to provide more support to families on the waitlist."
The Progressive Conservative government provided $490,000 to Klinic Community Health Centre, which runs the Trans Health Klinic, and $700,000 to expand access to GDAAY, according to a news release that was quickly removed from the government's website.
Up until this spring, the pediatricians, endocrinologists, mental health experts and others who have staffed GDAAY have done so through an "in kind" agreement with their employer — essentially, doing the work off the sides of their desks while managing other general duties because the program has never been formally funded.
The funding enables GDAAY to hire dedicated staff for the first time, including an administrative assistant, a program co-ordinator, a part-time social worker and a full-time child psychologist.
Cooney said the gap between 14 and 16 is something GDAAY is "hoping to be able to fill again" once they have staff in place.
The clinic tries to pair up kids and their families with a social worker while they wait, though Cooney acknowledged the stakes are high for kids who can't get the help they need.
"Specifically gender-affirming hormone medications, when they're indicated, they improve health and wellness and they decrease suicidality," said Dr. Cooney.
WATCH | GDAAY doctor discusses importance of supporting gender diverse youth:
Haran Vijayanathan, community health and wellness director with the Trans Health Program at Klinic Community Health, said trans and gender diverse youth face higher risks of mental health challenges and suicide, particularly when they don't have supportive people in their lives.
Long waitlists add another layer.
"That's often a huge challenge for individuals, especially when they've come out to themselves and they're comfortable with who they are," he said. "There's a lot of psychological and emotional trauma that they're experiencing because that process hasn't started."
Vijayanathan said the two-year funding commitment has helped the clinic boost staffing with four more peer support workers, add more nurses and nurse practitioners, and up patient time with psychologists and physicians. The first social worker at Klinic dedicated to trans care was also hired. But what's needed to keep the momentum going is "sustained" funding year over year, said Vijayanathan.
Dacey agrees. "I want to see that funding become permanent ... I'd like to see it basically removed from ideological lines. It's health care," Dacey said.
In the meantime, Parker Morran is hoping to have an impact as that new dedicated social worker at Trans Health Klinic.
They're one of the first points of contact for many who come through.
"My job is kind of a dream job; I get to hang out with trans people every day," said Morran, who is also trans and genderfluid. "I can relate to the people I meet with on that level because I've done it."
They said they waited eight months about a year and a half ago to get into Trans Health Klinic for their own transition care. Morran is now on hormone replacement therapy — testosterone specifically — and midway through another public health list for top surgery. It has an estimated two-year wait, they said.
They said getting on the lists comes with excitement in knowing the wheels are in motion. That's contrasted against the "limbo" of waiting.
"It's not fair to have to ask people to wait, really. It would be nice to be able to just call, register and make an appointment in a few months or less," they said.
Morran wishes gender-affirming health care was more of a priority in the health system.
"But I am glad for the progress that has been made in the last little while."
WATCH | Vijayanathan on hard fought 2SLGBTQIA rights:
If you or someone you know is struggling, here's where to get help:
- Talk Suicide Canada: 1-833-456-4566 (phone) | 45645 (text between 4 p.m. and midnight ET).
- Kids Help Phone: 1-800-668-6868 (phone), live chat counselling on the website.
- Canadian Association for Suicide Prevention: Find a 24-hour crisis centre.
- This guide from the Centre for Addiction and Mental Health outlines how to talk about suicide with someone you're worried about.
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