A gender-affirming care clinic at Mount Allison University in Sackville, N.B., has opened its doors to patients outside of the campus community.
Sara Thomas, a family doctor, began providing gender-affirming care to students at the university in September 2022 through Mount Allison’s wellness centre. In June of this year, Dr. Thomas went a step further, founding a gender-affirming care clinic on campus and opening it to patients across the province. Among its services, the referral-only clinic helps patients starting or maintaining hormone replacement therapy, assists with the approval process for gender-reaffirming surgery and provides referrals to other practitioners.
“There’s a huge gap in access to hormone therapy for patients who are gender diverse,” Dr. Thomas said. She notes that not all family practitioners have taken the necessary training to provide hormone therapy to help patients experiencing gender dysphoria – the sense that one’s biological sex does not match their gender identity. “I’m part of the queer community myself and I think it’s really important to have safe providers who can offer this care. So I’m doing my best to fill that gap.”
Dr. Thomas said that since opening the doors to the wider public, she’s received patients from the nearby Moncton and Sackville areas and from as far away as Saint John and Fredericton. She estimates that in the past three months she’s gained 30 or 40 patients in addition to 10 patients from Mount Allison that were already on her roster.
Jalila Jbilou, a medical doctor and an associate professor in the school of psychology and the faculty of health sciences and community services at Université de Moncton, said there is a definite need for more care of this type in New Brunswick, but it’s hard to know exactly what the need is. According to the 2021 census, about one in 300 people in Canada who are 15 years or older is transgender – about 60,000 people. But Dr. Jbilou said those numbers can be misleading.
“It’s just the [tip] of the iceberg because of the invisibilization of transgender people,” she said, adding that researchers and statisticians face numerous barriers to collecting accurate data on people’s self-reported gender identities, particularly among those living in rural and remote areas. “It doesn’t mean that they don’t exist. That’s where [more] research can help. We need to know: who are they, where are they, what are their needs, how can we better answer their needs? Because if we decide how to answer the needs without knowing … we are missing the shot.”
She said specialized clinics like Dr. Thomas’s are part, but not all, of the solution to providing affirming care where it’s needed. “We absolutely need more clinics, but more clinics [don’t] solve the problem. We need more awareness among all health professionals,” said Dr. Jbilou.
She noted that postsecondary institutions can help create a more inclusive health care strategy by making gender-affirming training fundamental to the education all primary care providers receive – including medical doctors, nurse practitioners, nurses, psychologists and social workers. She adds that this kind of teaching is already happening at the medical school at U de Moncton.
“Many people that I’ve talked to or I’ve seen have waited for years to access hormone therapy,” added Dr. Thomas. “As we know in general, the gender-diverse and trans population is much more impacted by negative mental health outcomes …[and] withholding this type of care by not providing access is really a bit of a failure on the part of our society.”
Gender-affirming care in a challenging political climate
The current political climate in New Brunswick seems at odds with an atmosphere of trans-inclusiveness. In June 2023 the province’s Progressive Conservative government made changes to Policy 713, which outlines the requirements for a safe K-12 school environment for 2SLGBTQ+ students. The changes mean that public-school teachers must refuse a student’s formal request to use their preferred pronouns or names if the student is under the age of 16 and doesn’t have a caregiver’s consent. In these cases, schools are also required to refer the child to a psychologist or social worker to develop a plan to involve the parents.
The policy changes – and Premier Blaine Higgs’s subsequent claim that there has been “a rapid onset of gender dysphoria” making the diagnosis “popular and trendy” – elicited a significant public response. Lawyer and former education minister Kelly Lamrock was ordered to conduct consultations about the changes with experts in education, law, mental health and medicine; his report, released earlier this month, concluded that the revised policy violates the provincial Human Rights Act, the Education Act and children’s charter rights.
Dr. Jbilou suggests the attention to gender identity issues brought about by the furor around Policy 713 could lead to a positive shift in care and services for transgender and non-binary people in the province.
“Those questions [around Policy 713] are very important because somehow they shake the social beliefs and the social values. Sometimes major change begins with these types of actions,” said Dr. Jbilou. “We have now a window of opportunity to step ahead to the future. …We see that with Dr. Thomas – she steps ahead to the future, and that’s what we need.”
For her part, Dr. Thomas plans to continue to offer gender-affirming health services to both students and the broader community this fall, and is hoping to set up a self-referral system which will allow people to book appointments directly on the Mount Allison website.