Gabriel Enxuga knows all too well the barriers to accessing gender-affirming care in Nova Scotia.
“For me, the process of starting hormones took almost two years, and in that time, my mental health really suffered,” they said.
That was more than ten years ago now, but Enxuga said many of the barriers that existed back then are still in place today.
“I feel like we’re really in a particularly difficult moment right now where our health-care system is so stretched,” said Enxuga.
“It’s always going to be the most vulnerable communities that are going to bear the impact of that, and trans people are definitely there.”
The biggest barrier to accessing care, they say, is simply a lack of physicians trained to provide that care, and they’re not alone.
“I finished medical school in 2011. At that time, there wasn’t any significant curriculum for gender-affirming care,” said Dr. Leisha Hawker, a family physician who received medical training from Dalhousie University and who now works at the North End Community Health Centre.
“I recall a brief lecture that got into patients with different sexual orientations and maybe some of the health-related risks that come with say, men who have sex with men, but I don’t recall any specific topics related to gender-affirming care.”
Hawker said once she graduated and began practicing, it became clear there was a need in the community for gender-affirming care.
“Early into practice I had several patients come to me, and they had been trying to navigate the system in accessing appropriate care for a year or more,” she told Global News. “And that’s when I told those patients, ‘Look, I’m not familiar, but I will do my best, and we’ll kind of work together as a team.’ And that’s when I started doing my own research, so, doing online studies, online courses, reading the guidelines.”
It’s unknown how many doctors in Nova Scotia are currently providing gender-affirming care. Dr. Hawker said she often takes referrals from other physicians who are uncomfortable with providing the care, but said the majority of people looking for gender-affirming care go to the Halifax Sexual Health Centre, where wait times can be years.
She said it’s been rewarding being able to help her patients navigate a system in which they have typically faced barriers.
“It’s really nice when you see a patient and they’re used to facing all these barriers and facing physicians who say, ‘I don’t know how to help, sorry, you’ll have to see somebody else for this.’ And when I say, ‘OK, yeah, let’s do this, we’ll work together as a team. This is the first step, and then we have to do this.’ And you can see the patient’s sigh of relief, their body language changes, they’re immediately smiling and just really excited,” Hawker said.
Dr. Laci Williams is the head of the human sexuality component in the human development unit in the first-year medical school curriculum at Dalhousie University’s Faculty of Medicine. She said the component does include gender-affirming care.
“There is one lecture delivered by the paediatric endocrinologist about gender dysphoria, the assessment of gender dysphoria, barriers/access to care, puberty blockers, and the basics of gender affirming hormone therapy,” said Williams in an email, adding there’s also a panel discussion for medical students on creating safe clinical spaces.
“One of the tutorial cases that the medical students work through during this component involves a transgender adolescent. It follows their journey after discussing their gender identity with their family physician and the process to access gender affirming care,” Williams said.
She said gender-affirming care is within the scope of all family physicians when they graduate, however so little time is spent teaching it that most are not comfortable providing the care. Should aspiring family physicians want more training, there is an option to do an elective course, she said.
That put’s the onus on the student, or the doctor to choose that additional training. Enxuga believes that training should be mandatory for all family physicians.
“We need to increase the number of providers who are able to offer these services, so that all new graduates out of nursing programs, medical programs, have knowledge not only around trans-inclusive language, but specifically around gender-affirming care,” said Enxuga.
“I think that gender-affirming care is still seen as a specialty, when often the services that are involved, especially around hormones, are actually fairly simple, routine, primary health-care matters.”
Hoping to make a difference
Enxuga is the co-founder of Lambda Health which launched in January. It’s Canada’s only 2SLGBTQ+-focused health co-operative, which offers virtual counselling, specifically for 2SLGBTQ+ people in Nova Scotia, Ontario and Quebec.
“We’re really focused on providing counseling that’s based on anti-oppressive values. So explicitly anti-racist, de-colonial, sex-positive, queer/trans-positive,” they said.
“I really feel that we are meeting a need.”
They said since launching only five months ago, there’s been a lot of interest in their services so far.
“We’ve had a lot of folks reaching out for support, especially coming out of COVID, especially queer and trans folks who may be feeling more isolated, have less community support, lots of barriers to accessing other mental health-care services or just health-care services in general,” they said.
“Risk of suicidality actually increases for trans people in that period of time between seeking gender-affirming care and actually accessing it. So it’s that period of waiting, when you’re navigating the system, you don’t know if you’re going to have access to what you need — you’re in limbo. And it’s really, really challenging for people’s mental health.”
“Don’t give up, it can feel hopeless, but it’s not. You can wait a long time, but you’re going to get the services that you need.”
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