N.S. Health works to expand access to youth gender-affirming care across province

Nova Scotia Health is working to expand access to youth gender-affirming care in the province by replicating a clinic model introduced in the Annapolis Valley last year.

In February 2024, a youth clinic dedicated to providing this kind of health care opened in Kentville. Then another opened this March in Bridgewater, with more clinics in the works.

"Accessing gender-affirming care isn't just a city thing or an urban thing," said mental health clinician Julien Davis, who is also trans. 

"We exist in rural settings as well and … ideally should be able to access that care wherever we're at."

The clinics provide puberty blocker and hormone therapy treatments to youth who have hit puberty, up to age 16. Children and their families can also be referred ahead of puberty to discuss questions and concerns.

Puberty blockers are a reversible treatment that temporarily stop the progression of puberty, providing a child with more time to explore their identity — for example through clothing — without the distress that can come with going through developmental changes. 

The blockers are not a new treatment, and have also been used for children who undergo puberty too early.

Hormone therapy is partially reversible and involves prescribing hormones like estrogen or testosterone to help trans and gender-diverse people develop physical characteristics that are aligned with their gender.

"These are medical treatments that have existed for a long time and they are available and safe for youth to access," said Becca Macdougall, a mental health clinician who sometimes refers patients and their families to the Kentville clinic.

According to the Canadian Paediatric Society, gender-affirming care — health care that supports a person's gender identity — is the standard of care for trans and gender-diverse youth.

The clinics operate under an interdisciplinary model, with pediatrics, mental health, nursing and pharmacy practitioners involved. 

Davis said the inclusion of nursing support is a unique feature. Nurses can help administer treatments that require injections, for example, but also teach youth how to do it safely themselves.

The goal is to open clinics across Nova Scotia based on the Kentville model, which Nova Scotia Health said was the first of its kind in the province outside of the IWK, while being tailored to local needs. 

According to Davis, who helped start the Kentville clinic, it's likely the next clinic to open will be in Sydney. That's because of the health-care professionals and resources already in place there.

Nova Scotia Health is also looking at Antigonish and southwest Nova Scotia as possible locations. 

Staff with the health authority travelled to communities throughout the province last year to discuss local needs, Davis said.

Hiring is also in progress for a gender-affirming care co-ordinator, who will help roll out the new clinics and engage with partners.

The founder of the Cape Breton Transgender Network said there's a need for these clinics, calling it a "very good move" to have multiple services under one roof.

"It's been difficult for a lot of folks who have to go to multiple different places [to access gender-affirming care], often having to go to Halifax," said Veronica Merryfield. "Those services need to be more localised."

She added that many families can't afford to take time off work to go to Halifax and back.

A referral from a primary-care provider — including through virtual care — and a readiness assessment for hormone therapy are required for patients to access the clinic's services.

The assessment can be conducted either by a private mental health clinician or publicly through Nova Scotia Health's mental health and addictions intake process.

Merryfield did express concern that the clinics could draw hate. In recent years the provision of gender-affirming care for youth has become increasingly politicized. 

"I'm hoping that these facilities are inside … another [Nova Scotia Health] facility," Merryfield said, to avoid drawing unwanted attention.

While negative rhetoric is out there, for Davis it's the youth who use the clinic that he listens to most closely. He said the Kentville clinic has heard nothing but positive feedback from those youth and their families.