Dear family doctors,
As the only clinic currently empowered by the Ministry of Health to make candidate recommendations for sex reassignment surgeries, we are managing increasing demands with very limited staff resources. At this time, our wait list is a year long to be seen.
We are encouraging you as family doctors to conduct your own assessments for hormone therapy (HT), working in partnership with other professionals and organizations as necessary. There are a number of excellent resources that might help you.
The World Professional Association for Transgender Health (WPATH) publishes the Standards of Care which walks one through the diagnostic criteria for Gender Identity Disorder, as well as the other considerations for eligibility and readiness. These guidelines are internationally regarded as Standards of Care for the treatment of trans clients.
If you feel confident in this regard, then you can make a decision to prescribe yourself, or if there are complicating medical risks, refer to endocrinology.
Sherbourne Health Centre has published Guidelines and Protocols for Comprehensive Primary Health Care for Trans Clients (available as a free pdf download from a link on their homepage or in hard copy for $10 from the RHO store. This document reviews contraindications, precautions and risks of hormone therapy. The protocol recommends physical and laboratory investigations to be done in advance of prescribing and offers typical doses and blood work monitoring schedules. A revised version is currently in the works which will detail guidelines for assessing psychosocial readiness for hormone therapy.
Rainbow Health Ontario’s Trans Health Connection is offering clinical training sessions for family doctors and allied health staff, until March 2013. In addition, its Mentorship Program provides regular teleconferencing sessions to further enhance the clinical confidence of professionals who may be less experienced in trans health. You can read more about the program and register by visiting their website or by contacting Coordinator, Jordan Zaitzow at 416-324-4100 x5325 to register by phone.
If there is a particular case where you do not feel confident given its complexity or have a concern regarding psychiatric morbidity, you may wish to refer to a local psychiatrist or psychologist resource to obtain a consultation regarding relevant issues, clinical impressions and recommendations, as part of informing your decision-making.
Increasingly common are physicians doing assessments jointly with a mental health professional (psychologist, counsellor, social worker, etc) where they feel an assessment can be jointly done between them. There are particular health care teams and individuals across the province with advanced knowledge in trans health. We recommend contacting Rainbow Health Ontario for a trans-friendly resource near you.
We are happy to consult with you as part of supporting you in this process. If after considering these resources, you still feel a referral to us is necessary, please send it as in the past, using the Adult Referral Form on the CAMH website.
Dr. Christopher McIntosh, Clinic Head and staff psychiatrist
and Dr. Nicola Brown, staff psychologist