If I had to describe the experience of accessing trans health resources in Nova Scotia, even for being a resident of the Halifax area, the simplest way would be a test of patience and financial means.
When first starting to navigate the system in early 2018, I was informed that it would take approximately two years to meet with a public psychologist or social worker, should I wish to pursue a hormone readiness assessment that was paid for by MSI. Choosing to go into a private practice, while giving a substantially lower lead time of one month, ultimately came at a significant cost: at the time, the going rate for private psychologists in Nova Scotia was $190 per hour, and by early 2022 it was $210.
After I finally received the letter confirming that the psychologist believed that I was ready to begin hormone replacement therapy, I reached out to the Halifax Sexual Health Centre to speak with one of their physicians for the three appointments required before a prescription could be issued. The first call I made was in May 2018, with no appointments available until July of that year. By the time I was able to begin hormone therapy, it was the end of July of 2018.
At that point, I knew full well that the standards of care set out by WPATH (World Professional Association for Transgender Health) dictated that hormone therapy was to be taken for a period of one year prior to eligibility for surgery, although I was not prepared for the conflicts that would eventually ensue with the public system in order to complete required appointments for readiness for gender-affirming surgery.
the province was reporting that more than 90% of cases were seen within four and a half months.
First among these was my encounter with Endocrinology at the Queen Elizabeth II Health Sciences Centre, where the province was reporting that more than 90% of cases were seen within four and a half months. When querying where my appointment sat, I was told that these reported times do not apply to transgender patients, never minding which the QEII informed me that only doctors in their clinic could issue letters, only for the endocrinologist I eventually met with to inform me that she could not do so, forcing me to endure an additional three month wait for a practitioner in Dartmouth on top of the eight months I’d had to wait to see an endocrinologist in Halifax.
During this time, where I was required to obtain two more letters, I was able to meet with the same private practice psychologist as before, but was encountering considerable difficulty in locating another clinician, as my family doctor was unable to provide one. Fortunately, PrideHealth was able to refer me to a social worker with the NSHA for an appointment with about two months lead time, while I was eventually able to get the final letter from my physician at the Halifax Sexual Health Centre.
After all of this was done, I needed to apply to MSI for funding approval for the gender-affirming surgery to be held in Montreal. This process was straightforward enough, but I was given to believe that it could be up to 90 days to receive funding approval, although upon personally reaching out to MSI, my application was approved after a simple phone conversation, as the person responsible for approving them stated that she moves the applications of those who call to enquire to the top of her pile, since the applications make their way to her in batches approximately once a month.
At every step of the way, the journey was hamstrung by delays in the process
Once the approval was obtained, it was about one month until I received a packet from the Centre Métropolitain de Chirurgie to complete health data for my patient record. This record, however, would take approximately six months before I was contacted by a nurse for further information before being passed on to receive a date, which took about another two months, the date itself being about three and a half months from the time of the call, although delayed by about three months due to the COVID-19 pandemic.
At every step of the way, the journey was hamstrung by delays in the process as laid out by the Nova Scotia government, leaving me feeling as though they operate under a different set of rules, or perhaps no rules at all for trans patients, leading to delays in receiving timely care that necessitated pursuing costly private options, or engaging in mentally exhausting levels of self-advocacy that only served to exacerbate the stress of trying to live in transition as it was.
