There are a lot of misconceptions regarding access to hormone replacement therapy. I’m here to help you navigate through this difficult process. If you are looking for medical resources such as doctors and clinics, please visit this page.

Should the information within this page be confusing, or if you have additional questions, please do not hesitate to reach out to Jennifer, who can help guide you through this process.

HRT & SURGERY FAQ

 Do I need to see a Psychologist/Psychiatrist to start HRT?

No. While it is generally suggested to have a diagnosis of Gender Dysphoria in order to access HRT, it is not required that a formal diagnosis be made by a Psychologist or Psychiatrist. Your family doctor or NP can make this determination and prescribe you HRT. See the bottom of this page for resources for doctors to help them with dosing and diagnoses.

 How long do I need to be on HRT before I can access surgery?

You must be on HRT for one year before accessing Gender Affirming Surgery (bottom surgery; not for top surgery).

 Do I need to attend a trans clinic in order to access HRT or Gender Affirming Surgery?

No. Your family doctor can prescribe you appropriate HRT without a clinic’s intervention, and can also refer you for Gender Affirming Surgery. For more information on the requirements for surgery, you can visit the government of Ontario site: https://www.ontario.ca/page/gender-confirming-surgery#section-1

 Is top surgery covered under the government of Ontario programs?

Breast removal surgery is covered with referral, however breast reconstruction is typically only covered if there is no breast growth as a result of HRT. For more information you can visit: https://www.ontario.ca/page/gender-confirming-surgery#section-1

 How long is the wait list for surgery?

Gender Affirming Surgery wait times vary greatly. Typically these surgeries are done either in Toronto or Montreal. It is best to speak with someone at a clinic that does referrals in order to get a sense of wait times, but usually it is from 1-3 years.

 What do feminizing hormones do?

The results of any HRT can vary from person to person. In general, the following effects are common on feminizing hormones: – Body fat redistribution – Decreased muscle mass – Softening of skin – Decreased Libido – Decreased spontaneous erections/male sexual dysfunction – Breast growth – Decreased testicular volume – Decreased sperm production – Thinning and slowed growth of body and facial hair You can find more information about the effects of feminizing hormones at the bottom of this page.

 What do masculinizing hormones do?

The results of any HRT can vary from person to person. In general, the following effects are common on masculinizing hormones: – Skin oiliness/acne – Facial/body hair growth – Scalp hair loss – Increased muscle mass/strength – Body fat redistribution – Cessation of menses – Clitoral enlargement – Vaginal atrophy – Deepened voice You can find more information about the effects of masculinizing hormones at the bottom of this page.

 How do I change my gender marker on my driver’s license?

In order to change your gender marker on your driver’s license (to M or F), you need a letter from a Doctor or Psychologist. If you are looking for such a letter and are unable to get one from your doctor, please send an email to jennifer@rootsinwellness.ca You do not need any supporting documentation to change your gender marker to an X. For more information, please visit: https://www.ontario.ca/page/change-sex-designation-your-government-ids#section-0

 How do I change my gender marker on my birth certificate?

You can complete an application to change your gender marker on your birth certificate, by visiting this website: https://www.ontario.ca/page/changing-your-sex-designation-your-birth-registration-and-birth-certificate Note that you will need supporting documentation from your Doctor or Psychologist for this.

 How do I change my legal name?

You can change your legal name in Ontario by filling out a form and completing a criminal record check. Visit this website for more information: https://www.ontario.ca/page/change-name#section-0

Resources for You & Your Doctor

Often, primary care physicians are reluctant to prescribe hormones therapy if they are unfamiliar with the process of obtaining HRT, or if they are unfamiliar with the different options. In this case, reaching out to a Psychotherapist, Social Worker, Counsellor, or Psychologist will not be beneficial, as none of these individuals are able to prescribe medication.

My advice would be to discuss this with your primary care physician, and work to educate them on the process so they may feel more comfortable. I have included a number of resources below for your convenience.

1. Protocols for Hormone Therapy: This document is a comprehensive, easy to read guide for primary care physicians to provide their clients with HRT, provided by Rainbow Health Ontario. It outlines the requirements for HRT, provides a list of terminology, steps for assessment, and includes a guide to the different types of hormones and their effects. This document is great for your physicians as well as for yourself if you are unfamiliar with the process.
2. Sherbourne Trans Care Guidelines: Sherbourne Health Centre provides trans individuals with HRT and integrative medical care as they move through their physical transition. They have created this comprehensive guide to trans care that outlines each potential stage of the process and provides individuals and practitioners with valuable information and tools.
3. Effects of Feminizing Hormones:This is a list of the different types of feminizing hormones and their effects; what to expect and what not to expect. From Rainbow Health Ontario.
4. Effects of Masculinizing Hormones:A list of what to expect and what not to expect when taking masculinizing hormones. From Rainbow Health Ontario.
5. Families In Transition: A guide for families of trans individuals. This guide includes terminology and offers an alternative, unbiased view to help families better understand and support their trans family members.
6. Trans Care for Youth: Sick Kids Hospital has a trans care clinic specifically for youth. A referral can be sent by your family doctor to begin the program.
7. TransHealthcare List of Gender Surgeons in Canada
8. Transition-Related Surgery FAQ for those considering surgery. This guide is below in full, and includes what is covered by OHIP and what is not, definitions, and the process for getting surgery.
9. Trans Primary Care Referrals & Advocacy. Includes support letters, changing sex designation, and process information.

Transition-Related Surgery

Therapy, HRT & Surgery

Name	Details
Hamilton Family Health Team	HRT, Surgery Referrals
Shelter Health Network	HRT, Surgery Referrals
Sherbourne Health	Trans Clinic, Resources
Rainbow Health Ontario	Service Provider Directory
London Intercommunity Health Center	Trans Friendly Services
Stonechurch Family Health Center	Trans Friendly Services
Church Wellesley Health Center	HRT, Surgery Referrals
Hamilton Trans Health Coalition	Service navigation for gender-affirming care
Connect-Clinic	HRT, Surgery Referrals
Quest	HRT, Surgery Referrals

You can find a full list of documents recommended by Rainbow Health Ontario for your primary care physician here.

For more information, resources, and support, please visit Rainbow Health Ontario or the Sherbourne Health Centre.

Additional Resources