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Accessing Care with Gender Dysphoria

“After the pathway I was no longer a diagnosis, I was a human being and it was one of the most validating experiences of my life.” Cedar*, 19

mapping supports for patients and providers

The Abbotsford Youth Health Centre (AYHC), has long known that transgender individuals make up a large portion of their patients with the most significant health needs. With 0.5% of the population identifying as transgender, it is estimated that there are 690 individuals in Abbotsford who could be living with gender dysphoria - a condition where a person’s emotional and psychological identity does not match their biological sex. Studies confirm that this population faces greater barriers to care, at times with devastating consequences.  

In 2016, Dr. James Liu, a family physician practicing at the AYHC, presented a proposal to raise awareness of gender-affirming care and resources, with the purpose of developing a clear pathway for those with questions and concerns about their gender. With support from the Abbotsford Division Board and the Shared Care Committee (a partnership of Doctors of BC and the BC government), the project launched, expanding to Fraser Valley East communities.

Getting Started

A multi-disciplinary Steering Committee was struck, led by Dr Liu, to bring all the appropriate partners to the table. Along with the Abbotsford Division, the team worked in collaboration with; Trans Care BC, Fraser Health, BC Children’s Hospital, Vancouver Coastal Health Trans Specialty Care, GPs and Specialists (pediatricians, psychiatrists and gynecologists), and allied health care providers, to identify gaps in care and discuss solutions. Transgender individuals and their loved ones were important members of the team, providing accounts of their own experiences, and what was needed on their gender affirming journey.

A Learning Process

Over the course of their work, the team learned that a number of issues were contributing to a fragmented and sometimes confusing experience for those seeking services and support.

Primary care physicians indicated they were lacking education and information on how to care for transgender patients. As a result, patients were being referred directly to a Specialist, even if this may not have been necessary.

Accessing resources and services were a challenge. Often, physicians and patients were unaware of services or where they were located. Many services are located outside of Fraser East with complex or unknown referral systems, criteria, wait times, and costs. The team learned that some patients simply did not pursue care due to frustration.

Sarah*, a parent support and advocate at the youth centre, was acutely aware of these challenges, as she helped families of transgender youth navigate the complex medical maze. In her role she heard heartbreaking stories from young people who were targets of violence, discrimination, sexual harassment and ostracism; many facing risk of suicide and harm from self-treatment.

Sarah acknowledges that it was terrifying when her own 15 year old daughter, Cedar*, shared that she’d been living with gender dysphoria since she was 11 – stating in her own words that she felt “that her body did not match her mind”. She, like many of the transgender individuals for whom Sarah was advocating, was also living with anxiety and engaging in self-harm. Sarah was invited to join the project to provide her valuable perspective.

With Sarah’s input and that of the multi-disciplinary team, practical ‘roadmaps’, pathways, and tools, were created to support the unique needs of each individual on their gender-affirming journey, and to guide those caring for them. These included:

  • a confidential Gender-Affirming Care Pathway for Primary Care Providers
  • a Gender-Affirming Roadmap for Individuals and Loved ones
  • Tips for Creating a Trans-Inclusive Clinic and Environment
  • The creation of a community of practice
  • Education workshops to enhance clinical skills

The Benefits

Dr. Liu shares, “It’s been quite a privilege to work directly with people with lived experience, and to participate in something that hopefully addresses an unmet need, and that helps individuals and their loved ones feel less lost,” he says.

Sarah states that prior to the gender-affirming care pathway, they felt isolated and alone in trying to navigate the system. Now navigation is shared with a community that has been instantly created to provide care.

From the providers’ perspectives, Dr. Liu states “It’s helping providers feel a sense of professionalism, to feel included, and to take part in the care of their patients, whereas before they had been feeling almost obligated to direct care away from themselves.”

Cedar, now 19 said “after the pathway I was no longer a diagnosis, I was a human being and it was one of the most validating experiences of my life.”

* Names have been changed to protect anonymity

Resources

The division is sharing resources with other communities through Pathways BC. Patient resources are available here.

For more information contact the Abbotsford Division of Family Practice at: abbotsford@divisionsbc.ca

 

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