Nova Scotia aims to reduce 2-year wait for transgender health services

Nova Scotia needs to cut down wait times for transgender patients planning to undergo a medical transition, says the executive director of an organization that supports youth with issues of gender identity.

Kate Shewan of the Youth Project says it's especially important since those patients may be losing their entire support system as they come out as trans.

"Often they're dealing with a lot of anxiety, sometimes depression," said Shewan, who leads The Youth Project.

"They may lose their friends and family connections, which can multiply the amount of distress and things that are being felt."

Demand on the rise

Demand for hormone therapy or gender affirming surgery is growing significantly in Nova Scotia, says Shewan.

But the exact numbers aren't known.

Trans patients can be treated by family physicians, endocrinologists, nurse practitioners, even speech therapists.

Each type of therapy has different billing codes, making it challenging for the Nova Scotia Health Authority to assess the demands on the health-care system.

Often people are getting off one wait list and they're hitting another wait list- Kate Shewan

"Navigating to all those referrals and assessments and associated treatment along the way, if needed, is complex to navigate and time-consuming," said Kolten MacDonell, the health services manager for the health authority's central zone.

The health authority is starting a research project, funded by the QEII Foundation, to cut through those roadblocks.

Shewan is the community advisor for the project, which aims to hear stories from patients, community leaders and health-care providers.

"Often people are getting off one wait list and they're hitting another wait list," she said of the way things are now.

The health authority agrees that change is needed, pointing to global research that says as many as 45 per cent of trans people attempt suicide at some point.

MacDonell says they follow standards set by the World Professional Association for Transgender Health, or WPATH.

In a policy statement, WPATH emphasizes that transgender surgeries are not cosmetic or elective. 

"These reconstructive procedures are not optional in any meaningful sense, but are understood to be medically necessary for the treatment of the diagnosed condition. In some cases, such surgery is the only effective treatment for the condition, and for some people genital surgery is essential and life-saving," the association said.

MacDonell says offering faster access for trans patients is a complex problem that can begin with the need to have a family doctor.

There's a wait list for a family physician in Nova Scotia that currently has 52,507 people registered.

"It's an additional step in the process that takes additional time, in a time that is really important to have timely access," said MacDonell.

Changes that can be made now

MacDonell is passionate about the potential of the project, which he hopes will give the health authority a better understanding of the challenges faced by patients.

The team has one year to come up with a plan, and then another year to implement change and streamline the process. ​​

Shewan, however, hopes the health authority doesn't wait for their work to be done. She says there are clear changes that can be made now.

She believes in some cases, assessments could be reduced or eliminated.

Some clinicians are actually restricted in the amount of time they're allowed to dedicate to trans cases. 

"I do want to see resources added to addressing the issues and not wait and see what comes out of this project."