Two surgeons in blue coats wearing yellow surgical masks work on an unseen patient
Photo: Pavel Sorokin/Pexels

Gender Affirming Care Nova Scotia (GCANS) is applauding a provincial government decision that will mean fewer barriers and shorter wait times for Nova Scotians seeking gender-affirming surgeries, but says this is just the beginning.

“Gender Affirming Care Nova Scotia is happy to hear about the recent changes made by the Department of Health and Wellness to decrease barriers to accessing gender affirming surgeries. This is an important step forward for our failing system,” the non-profit organization wrote in an emailed statement to the Halifax Examiner on Wednesday afternoon.

“But it is, at the end of the day, one step in a marathon to address the inequalities the Trans, Intersex, and Gender Diverse Community experiences in healthcare, both generally and in gender affirming care. We are hopeful that this is a sign of what more is to come in the near future.”

A tweet that says Every journey begins with a single step, and this is an important first step taken by ns health today. We want to both celebrate that changes have been made, while recognizing that we must keep going and pressuring government for more changes.
A Gender Affirming Care Nova Scotia tweet shared Wednesday morning.

In a media release Wednesday, the Department of Health and Wellness said effective immediately, the province was removing barriers and cutting wait times for Nova Scotians seeking gender-affirming surgery.

“People told us the application process for gender-affirming surgery created needless hardship and painful delays in getting the care they need. This can have a serious impact on their mental health, and it hurts gender-diverse people and their loved ones,” Health and Wellness Minister Michelle Thompson said in the release.

“We’ve listened, and we are making changes the community recommended. We will continue to work with transgender and gender-diverse Nova Scotians, hear their needs and offer supports more quickly.”

As the Halifax Examiner reported here, the non-profit Halifax Sexual Health Centre (HSHC) publicly expressed its concerns in May about two new and “significant” barriers to gender-affirming care (GAC) in Nova Scotia.

The organization’s executive director shared that the only provider of gender-affirming surgery had announced he was no longer offering services due to MSI (Medical Services Insurance) billing code issues. In addition, two specialists (endocrinologists) who provided letters required by MSI for patients to have their surgeries publicly funded said capacity limitations meant they were no longer taking referrals.

“Delayed care for trans folks is a life-impacting situation. The risk for suicidality and other mental health concerns is massive, and this hindrance is huge,” HSHC executive director Abbey Ferguson told the Examiner at the time.

Removing barriers

In its media release on Wednesday, the province said surgery applications no longer require a letter of support from a Nova Scotia specialist and a letter from a specialist confirming post-operative care for surgeries that take place in the province.

The department said axing the requirement for those letters will “significantly” reduce wait times as it can take between six and 18 months to see a specialist. This more than doubled wait times for patients.

However, if the gender-affirming surgery happens outside of Nova Scotia, a letter from a physician or nurse practitioner confirming post-operative care is still required.

A psychosocial assessment letter is also still required with a surgery application, but the province said more health care providers are now able to provide those letters.

“Now, physicians, nurse practitioners and specialists who have specific skills in gender-affirming care can complete the assessment, provide the letter and sign the application,” the release said.

The province said this change will also help reduce wait times because patients will no longer have to find (and wait) to access specific mental health clinicians trained in gender-affirming care to complete the process.

A great step

In the media release, Abbey Ferguson, executive director of Halifax Sexual Health Centre, said members of that organization were “thrilled” to learn the province had recognized community advocacy efforts to reduce these barriers.

“We are confident that the changes to the application process will have a positive impact on our patients,” Ferguson said. “We are excited to reach out to patients currently awaiting specialist letters to tell them the good news.”

The executive director of Sexual Health Nova Scotia was also quoted in the release, describing the changes as an important step in reducing barriers and creating more equitable systems of care.

“Sexual Health Nova Scotia is thrilled that trans and gender-diverse people around the province have been consulted, resulting in positive changes to the process of accessing gender-affirming surgeries,” Stella Samuels said.

Also quoted in the release, Nova Scotia Health’s prideHealth co-ordinator Garry Dart said these changes will make it easier for trans, non-binary, and gender diverse people to access the care they need.

“This is a great step toward more equitable access to gender-affirming care while reducing barriers and stigma,” Dart said.

Nova Scotia has the highest proportion of trans and gender diverse people between the ages of 15 to 34 in Canada.

The Department of Health and Wellness notes the 2SLGBTQIA+ community makes up between 10% and 20% of Nova Scotia’s population. Gender-affirming surgery has been an insured benefit since April 1, 2014.

Last year, 101 applications were approved for these surgeries in the province.

In a tweet Wednesday afternoon, Doctors Nova Scotia also applauded the government’s announcement.

A tweet from Doctors Nova Scotia that says This is welcome news and will help address the barriers trans and gender-diverse Nova Scotians continue to face when seeking gender affirming care (GAC). It's key to provide GAC across the health-care system and work toward providing better care to all Nova Scotians. The tweet below it reads Province Reduces Barriers for Nova Scotians Seeking Gender-Affirming Surgery
Doctors Nova Scotia/Twitter

“Trans, non-binary and gender-diverse people face many hurdles in their journeys before they even access life saving gender-affirming healthcare,” Veronica Merryfield, founder of the Cape Breton Transgender Network, said in the province’s release.

“Removing delays, barriers and simplifying their passage is a welcome step towards easing that unnecessarily difficult journey. I look forward to being part of that further easement of those journeys and want to thank the team for this step.”

More information, as well as the list of publicly funded gender-affirming surgeries in Nova Scotia, are available here.

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Yvette d’Entremont is a bilingual (English/French) journalist and editor who enjoys covering health, science, research, and education.

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