FAQ · Personal Experience · Politics · Transition

Accessing HRT in Alberta

It started over a year ago with a trip to my doctor to renew a prescription for asthma meds.

By that point, I knew I wanted to transition and had logged about 15 to 20 research hours mapping out the process. The first step, I had deduced, was to find a doctor who would be onboard, who wouldn’t act like a gatekeeper. The likelihood of finding a doctor in the small northern Alberta town I live in, who had prior experience with transgender patients or transition seemed low. It seemed more probable that I could find a doctor with no direct experience but the willingness to learn.

What I had learned was:
1. Supportive GP is needed for referrals.
2. They refer you first to a psychiatrist.
3. Psychiatrist confirms gender dysphoria diagnosis.
4. Then your GP refers you to an endocrinologist.
5. Endocrinologist starts you on HRT and GP follows up.

Since I needed the asthma meds anyway it seemed like a good chance to troll for doctors and see if there was one who gave me a good feeling. Then I would ask to see them at their next available time slot where I would come out. I was lucky, the doctor gave me a very good feeling, with literally no other guidance to go on, feelings were all I had. After getting my prescription refilled I booked a “follow-up” appointment, at the next available date and was vague about the reason why.

Two months later I was back in the same clinic waiting for my follow up. I was so nervous, the nurse took my blood pressure three times because it was so high. I clung desperately to doctor-patient confidentiality and didn’t disclose details to staff or nurses, saying I was there for a prescription refill instead.

My appointment went about as well as I had hoped. As anticipated the doctor had no experience with transgender patients. However, I should point out this clinic was their first posting following their residency in med school, most things were new. What surprised me was that they said transgender health, or transitioning was never ever mentioned in their eight-plus years of medical school…

As I came out, they listened, displayed empathy then assured me that though they didn’t know the next step on their end exactly, they would figure it out.

“It’s going to be an exciting journey,” they told me.

In Alberta accessing Hormone Replacement Therapy (HRT) as an adult (18+) is easiest done through ‘informed consent.’ Essentially it means I accept the consequences of my actions should they go awry – that if I regret HRT I do not turn around and blame/sue the Government. What that entails is first a referral to a psychiatrist to obtain a diagnosis of Gender Dysphoria, however, you must also prove you are of sound mind, hence the informed consent component. I described it as appearing crazy but not too crazy. After that, your doctor can then refer you to an Endocrinologist to initially begin HRT.

It sounded so simple…

My referral to the psychiatrist was sent along to the nearest available office, located a cool 200km away. However, what Alberta Health Services (AHS) did not communicate to the primary health clinic in my region was that they had centralized all referrals through a new system called the North West Crisis Management Centre, or something similar. My referral was bounced back because of this and then was resubmitted. It was then three weeks until I heard from the clinic and another three weeks after that before their first available booking.

Eight weeks after the initial referral from my doctor was sent, I took a day off work in order to drive 500km round trip to see the psychiatrist. Upon arriving at check in I was told that they had been double booked and were in a meeting. I stayed calm and told them I could not just return for a follow up because I lived two hours away. After waiting another 45 minutes or so they managed to squeeze me in.

The appointment was terrible, I’ll start by saying that the doctor had to look up gender dysphoria in the DSM V while I sat in their office waiting. My referral form said why I was there and I was clear when I got there. What was truly upsetting though was that I required this person’s approval to move ahead with HRT. I needed a government doctor, with no experience or empathy to diagnose me with something they didn’t understand. Additionally, it became apparent through the meeting that they didn’t feel gender dysphoria was a mental illness (on this point we agree) but also apparent that they don’t think transgender people exist. I literally had no choice but to sit there, questioned by a bigot with a PhD and I had to smile about so they would give me the stamp of approval and I could move on. It was a disgusting process.

After a brief emotional breakdown in the back of my car outside the hospital, I drove home. It fucking sucks being pathologized by someone who displays contempt for your existence.

Once again it was back to my family doctor, who had caught up and run ahead. Now they were leading the appointments and had already gone ahead and started the next referral process. Once again I had a bit of an emotional moment in the back of my car though this time it was because of the kindness demonstrated by a person with a PhD.

It was a few weeks before I heard anything, then I received a letter in the mail from the University of Alberta’s Endocrinology Department, with an appointment date. I was freaking ecstatic, it had also been just about two years since I had last been to Edmonton so it felt like I was due for a trip.

Through research I had concluded it was reasonable to expect to have my blood drawn, a follow-up appointment booked and to get a prescription for Spironolactone a.k.a “Spiro,” it’s an antiandrogen, which inhibits production of testosterone. Otherwise, I had no idea what to expect.

I made sure to Google the Doctor’s name, I had done this with the previous Doctor too and I remember feeling concern when the psychiatrist yielded no results from the trans community online, negative, positive or otherwise. They were known for trauma recovery but not gender dysphoria. I’ve since concluded that the lack of presence was a red flag I failed to see. So I searched Dr. Donald Morrish and his name popped up in a trans-related Reddit thread with generally positive reviews.

I breathed a big sigh of relief.

After a tense summer of anticipation, my partner and I went to Edmonton. Everything went better than I ever imagined. For example, I still use my birth name on documents, I haven’t gotten around to the change of name yet. While talking with the nurses at the hospital, the staff used that name, it’s also the name on my birth certificate. When the doctor came to get me from the waiting room he addressed me by the name Autumn instead. That was a hugely positive sign.

The appointment went better than I hoped. He outlined in detail how HRT worked. Prescribed me spiro, as well as estrogen and progesterone and dispelled many of the myths people have pushed on me regarding transition. Namely that people regret it and that estrogen does not cause patients to report mood swings.

From left to right, the anti-androgen Spironolactone, and hormones Progesterone, and Estrogen (in gel form).

The only doctor I needed to see, other than my GP was the endocrinologist. Ultimately I’m using the same gel the post-menopause cis women are prescribed but I guarantee they did not have to prove they were sane before being allowed to access HRT.

So to Alberta’s NDP, you inherited a number of broken systems constructed by the PC’s. You have the chance to dismantle them and treat trans people equitably. Will you? Or will you leave in place these psychiatrist gatekeepers?

I will be writing to Health Minister.

It should not have taken me 14 months and three doctors – this was a phenomenal waste of my time and money, as well as Government of Alberta’s time and money. However, it was the government that made the waste, from my perspective, a necessary hurdle.


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