Accessing Medical Gender Affirming Care
Gender affirming medical care (GAC) includes a range of treatments such as hormone therapy, voice training, surgeries, and permanent hair removal. However, this part will focus specifically on hormone replacement therapy (HRT) and OHIP-funded surgeries.
Accessing medical gender affirming health care (GAC) usually begins with your primary care provider (PCP).
If your PCP feels managing GAC is beyond their clinical competency, they have a professional obligation to provide a timely and effective referral to a qualified medical professional.
Accessing Hormone Replacement Therapy (HRT)
In Ontario, prescribing hormone replacement therapy (HRT) operates on an informed consent model. A prescriber does not need a psychological evaluation or a diagnosis of gender dysphoria to begin the process.
A willing physician (family doctors or specialists) or a nurse practitioner can prescribe hormones once they make sure you fully understand the medical effects, risks, and timelines. Once again, if your PCP cannot prescribe HRT, they must refer you to a specialist (like an endocrinologist) or an affirming clinic/clinician that uses informed consent.
Self-Medicating HRT (DIY)
For a variety of valid reasons such as negative experiences with the formal healthcare system, accessibility, or desiring more control over hormone therapy, some trans people may choose to self-administer hormones outside of a formal healthcare setting. For more information, see here.
Accessing Transition-Related Surgeries (TRS)
Unlike HRT’s informed consent model, OHIP-funded surgeries require provincial approval. Different surgeries require different formal surgical assessments (e.g., chest surgeries require one assessment whereas bottom surgeries require two).
After your provider submits the funding application, the Ministry of Health must approve it before any surgery can take place.
See this guide’s page on TRS and Rainbow Health Ontario’s TRS Frequently Asked Questions for information about assessments, referrals, and OHIP coverage.
GAC Guidelines
Guidelines for Ontario
- Rainbow Health Ontario’s Gender Affirming Care Guidelines
- Quality Standards for Gender-Affirming Care for Gender-Diverse People by Ontario Health
Guidelines In Other Healthcare Jurisdictions
Most other health systems adhere to WPATH standards. You may find it helpful to review out-of-province guidelines as it can provide alternative regimens and insights to share with your provider.
Other Guidelines
- Clinical Guidelines with Information on Transfeminine Hormone Therapy - Transfeminine Science