Hormone therapy (sometimes called cross-sex hormone therapy or hormone replacement therapy/HRT) involves taking medications that cause the body to develop secondary sex characteristics, such as hair growth (testosterone) or breast development (estrogen).
Information on hormone therapy:
Contact the IWK's Transgender Health Team:
There are two pathways to getting gender-affirming hormones:
Your family doctor or nurse practitioner should be able to help you get started on hormone therapy.
If you have a family doctor or nurse practitioner and they are informed about trans health, ask them for a hormone prescription. They may be qualified to assess hormone readiness and prescribe and monitor hormone therapy. Some family doctors and nurse practitioners may also prescribe based on the informed consent model (see below).
Some may feel assessing and prescribing is beyond their scope. In this case, use the Hormone Prescription with Assessment by a WPATH SoC-trained Clinician pathway.
The informed consent model respects a trans person's right to self-determination. It does not rely on a diagnosis of gender dysphoria as a prerequisite to prescribing hormone therapy.
If a health care provider is operating from the informed consent model, they may not require a mental health assessment before starting hormone therapy. Informed consent ensures you understand all the information about hormone therapy and accept the risks involved.
Some health care providers may want to make sure you understand all relevant information so you can make the best decisions about your care. This might involve talking to you about your goals and expectations, and giving you information about the likely physical changes, side effects, and fertility preservation options.
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Assessments (also known as readiness assessments) explore any social, mental or physical health concerns and the risks and benefits of hormone therapy. In Nova Scotia, assessments for hormone therapy are done by clinicians trained in World Professional Association for Transgender Health (WPATH) Standards of Care.
Only certain health care providers who are trained in the WPATH Standards of Care can perform an assessment. Trained health care providers include psychologists, psychiatrists, social workers, mental health counsellors, marriage and family therapists, nurses, or family medicine doctors with specific training in behavioural health and counselling.
The assessment will include up to three appointments. The health care provider doing the assessment is trying to understand your gender dysphoria. They will ask you questions about your expectations for treatment, support systems, and current mental health status, and make sure you understand informed consent.
Remember: you have the right to ask the person doing the hormone readiness assessment for a copy of your letter and to clarify any information that is inaccurate or confusing.
You can also access WPATH practitioners through community mental health by calling 1-888-429-8167. Tell them you need a hormone readiness assessment letter. The person on the phone will do an initial screening and make decisions on where to refer you based on where you live and wait times. You will then be placed on a waitlist and forwarded to the first appointment at the closest mental health clinic. You can expect to wait up to six months before you see a clinician.
To get referred to private clinicians who are trained in the WPATH SoC (please note that, coverage for private clinicians is based on your private health insurance policy. If you do not have private health insurance, you will need to pay out of pocket when you see a private clinician. The benefit of seeing someone private is less of a wait time compared to the public mental health program. If you do have private health insurance, you may still need to pay out of pocket if your insurance company does not direct bill.
prideHealth can also refer you to a social worker at NSHA who can do your assessment. The wait time is approximately 3 months.
Call HSHC and ask to be placed on the waitlist for new trans clients. Each trans health provider at the HSHC takes one new trans client each month. The general wait time is around 6 months. HSHC can also refer you to a social worker at NSHA who can do your assessment. The wait time is approximately 3 months.
Note: HSHC does not become your family health care provider. They will only monitor your transition, reproductive, and sexual health concerns. HSHC is self-referral only you need to call yourself (no one can book an appointment for you) to book/place themselves on the waitlist. Hormones are usually done in 3 appointments.
Your health care provider will ask about your family, medical and social support history as well as general health questions. Know your family history of: cancer; cardiovascular disease; dementia; Parkinson's disease; muscular, skeletal (bone density), bladder, kidney, and liver issues; and any mental health diagnoses.
You will be given a requisition for blood work to capture the baseline functions of your systems. The aim is to make sure that adding hormones won't compromise your health.
You will be given reading material with all the information you need about what changes to expect, all possible side effects, and what types of monitoring will be required.
Your health care provider will review your blood work. If there is anything that needs to be monitored, they will refer you to a specialist.
There may be some components of a physical exam. For anyone with a cervix, cervical cancer screening (Pap test) will be discussed.
The consent for hormone treatment is signed.
After getting the prescription, if your hormone therapy involves injections, you can make an appointment and your health care provider will teach you how to do this yourself. You can bring a support person with you.
Injection supplies can be bought at a low cost at Halifax Sexual Health Centre (HSHC).
Your health care provider will tell you to get blood work done at a certain time and to follow up with them after. This is to monitor what hormone therapy does to you. Hormone initiation and dosage changes often require frequent follow-ups.
Injection teaching (only for those who are on injectable hormones)
Nurses at the HSHC can show you self-injection techniques. The aim is to teach you everything you need to know so you can self-inject by the third visit.