This doctor travels to Windsor to bring more gender diverse care 'closer to home'
Clinic in Windsor looks to bridge gap in services
About once a week, Dr. Ian Johnston makes the trip from Chatham-Kent, Ont., to Windsor, Ont., to meet with and care for young people who are questioning their gender identity.
He does this to bring more timely supports closer to the people who need it.
"The number of teens and children looking for care far outstrips the capacity for it," said Johnston, who has been running the Youth Gender Diversity Clinic in Windsor since March.
"Waiting lists at big clinics have gotten completely unmanageable. I think they're 18 months in London, they're two years in Toronto, which may not seem huge but if you're a struggling 13 or 14 year old, if your children need to wait two years to even see someone ... it's a pretty distressing situation."
Since Johnston's clinic began, he said he's had about 15 patients.
The clinic offers people 18 years of age or younger hormone blockers, affirming hormone therapy and continued treatment through the Windsor-Essex Community Health Centre. Johnston said he aims to get parental consent where possible, but can treat people without it as Ontario doesn't have an age of consent.
Johnston said he's the only doctor in Chatham-Kent providing this care and believes he's the only one offering it to teens younger than 16 years old in Windsor.
Johnston and Trans Wellness Ontario told CBC News that the gender diverse community doesn't always feel well served in the Windsor-Essex region due to a lack of resources or gender diverse expertise from physicians.
Barriers to care
Nona Abdallah, who is a trans woman and gender fluid, told CBC News that wait times, but also judgment or a lack of knowledge from physicians, are some of the barriers the community faces.
"One time [a doctor] commented on my breasts, they're like 'oh wow your breasts are getting really big, I haven't seen that,' and it just ticks something in your brain like this is weird," said Abdallah, who is a peer mentor and group facilitator at Trans Wellness Ontario.
Abdallah said experiences like this made them feel uncomfortable and were part of the reason why they decided to find care elsewhere.
They said they've also had doctors admit to not knowing much about hormone therapy or how to provide follow-up treatment.
Juliana Simon, a registered social worker at Trans Wellness Ontario, said people also find it challenging to get a hormone replacement therapy referral from a family doctor, as some don't have one.
She added that sometimes family doctors think only an endocrinologist can prescribe hormones.
But that's not the case — family doctors in Ontario can provide hormone replacement therapy.
"I find that some medical professionals that we come in contact with just don't know and it's not that they don't want to know, it's either they don't have the time to find the information or they don't know how to vet the information," said Simon.
"What I'm seeing is a lot of the times clients are going to find the information on their own and bringing it to their doctor."
As a physician, Johnston said he understands first hand the hesitation doctors might experience when approached by a non-binary or transgender patient.
"When I first began doing this type of work it wasn't intentional, it was really by accident," he said, adding that it started when a patient approached him.
He quickly learned that this wasn't "rocket science."
"It's something that can easily be done by a generalist, by a pediatrician, by a family physician, it's just a matter of developing a bit of comfort, a little bit of experience and most importantly devote some time to dealing with this population."
While his clinic prefers a physician referral, he said they also take self-referrals to remove that barrier.
Controversy can hold doctors back says Johnston
But Johnston said he knows that this is still a practice doctors shy away from because it can involve speaking with a concerned family or handling a person who is in distress and dealing with mental health issues.
Johnston said the controversy that surrounds youth changing their gender also creates hesitation.
"Doing nothing is not a benign intervention at all," he said.
More visibility, better communication among service providers, increased supports for family and an onus on physicians to train themselves in caring for this demographic were some solutions suggested by Trans Wellness Ontario and Johnston to improve care.
Simon said she'd like to see a "one stop shop" in Windsor where the LGBTQ community could go to have mental, social and medical needs met.
As for Johnston, he strongly believes that there needs to be more doctors offering this care and hopes his clinic can encourage more resources in smaller Ontario communities.
"People feel or imagine that gender affirming care needs or is always done in bigger centres and hopefully I'm demonstrating that that isn't the case," he said.