Safely, legally, and without travel, accessing CAMH, Sick Kids, etc.

**My experience has been through using the Ontario Telemedicine Network (OTN) – if your city/ community/ town does not have access to this, other methods of contact may be used. I also only required two appointments – this is by no means a standard, minimum, or maximum, just what happened for me. Also, you do not have to be 18 to access HRT in this way. Folks younger than 18 can follow the same process, though may be more inclined to access hormone blockers opposed to T or E.

This was and these are my own experience(s), and I am hoping that yours is equally comfortable and quick. I’d appreciate hearing any variances from (or similarities to!) my own experience to anonymously add to this brief guide – this would further encompass what other folks can expect during their own processes. If you are comfortable and willing to share, you can anonymously contribute by emailing myself at nonbinarynoise@gmail.com, or contacting me through the form on the Contact page.

Where do I start?

1. Work through what you are clearly seeking, and be able to articulate that thing or those things

Are you seeking low-dose estrogen or testosterone? Are you 16 or younger and seeking hormone blockers? Are you looking to gain what is socially understood as ‘masculine’ or ‘feminine’ traits? Are you looking to occupy a gender presentation that is more outside of the gender binary or somewhere along a fluid-type-spectrum? It will help greatly to be able to articulate exactly (or roughly) what you are looking for. For example, I was seeking low-dose testosterone to begin non-binary medical transition. I was wanting a lower dose to slowly and gradually adjust, see how my body would respond, and increase as needed. I was seeking to ‘masculinize’ my body to a point of further comfort, such as a deeper voice and less-pronounced hips when fat redistributes in the body. Having a few simple sentences to summarize what you are wanting is beneficial. Also being prepared to answer relatively non-invasive questions such as “Where do you see yourself now in regards to your gender?”, “How would you describe your gender?” – you do not have to answer ANY of these that don’t feel right, but being able to do so articulately sped up my process of obtaining a prescription. Dr. Blair Voyvodic (your main contact in all of this) stated multiple times that being able to describe where I am at, who I am in regards to my gender, what I am seeking, etc. clearly was a very healthy and helpful thing (on many levels, but also in accessing HRT). Do some You work, maybe find some words that help you describe what you feel you’d like to, spend time with any emotions that may arise during that process, talk it out with someone if you can/ want to, and be gentle on yourself in doing so.

2. If applicable, let your family doctor in on what you are seeking

Applicable in the sense of having a family doctor or routinely-seen registered nurse in your community, and applicable in the sense of having a care provider that you believe would not be transphobic, queerphobic, etc. Do not put yourself in any positions of disclosure that may leave you uncomfortable or unprepared to discuss at that time. I found it was very helpful (and incredibly fortunate) to have a family doctor I had been seeing for a number of years who was very supportive of me seeking HRT. She had no experience in prescribing HRT to trans patients (dosages, what to monitor during routine blood work, etc.) and was honest with me in saying so, but having her support and backing was very helpful.

3. Self-refer via email or telephone

Send an email briefly detailing what you are seeking to Dr. Blair Voyvodic at blair.voyvodic@ontariomd.ca, or call his office at 1 (416) 804-2110 and leave a message with him. He is fluent in both English and French according to his posted information. You’re just requesting an appointment or simply stating you are seeking HRT, and leaving the best contact information to reach you at – whether phone or email. I’ll post a bit from his Rainbow Health Ontario profile to help you get a better feel for what kind of doctor you’ll be chatting with:

“What I offer: Affirming counselling and, if appropriate, initial prescribing for trans people interested in hormone treatment. I provide this after hearing from many trans people that they have tried accessing hormones from other doctors but were told the doctor did not feel they had enough experience to prescribe them. Once someone has been through the initial assessment and prescribing, they are in a stronger position to find a doctor for ongoing monitoring and prescribing. I also work with Trans Health Connection in training more doctors to be knowledgeable in hormone prescribing.

Who I am: A medical doctor with a keen interest in mental health and social justice, and with diverse experience over the past 25 years. My work is based on an understanding that each of us thriving personally is linked to freeing ourselves and society from oppression of all sorts. I enjoy doing what I can in a sustainable and healthy way to make the world a better place.”

4. Wait for a response from his office, then schedule an appointment

I received an email back from Blair in two days, and after a few messages back and forth, a staff from his office emailed me to schedule an appointment with him (I emailed him on the 1st of June, and had an appointment booked through the OTN by June 15th).

To set up an appointment, you will need to provide the following information: the name and number on your OHIP card, gender marker on your OHIP card, home address, phone number, and date of birth. If you cannot provide any of these pieces of information, mention this to Blair to discuss alternative options. I had an appointment booked for July 9th – only a month after initially contacting him. This appointment was through the Ontario Telemedicine Network (OTN), which is essentially a network of hospitals, clinics, and the like that connect Ontario doctors with Northern Ontario communities and cities. It’s a large Skype-like network that MANY Northern communities have – Blair will help you in locating one in your community or one as close as possible. Personal contact may also be possible, but I have not had to take that route. Again, he is incredibly open and available for questions, so don’t hesitate to ask whatever you need to. **Please note that in my community, OTN appointments that are not referred by a family doctor/ RN cost approximately $100.00CAD out-of-pocket, as it is not currently OHIP-funded or covered unless referred. Your family doctor can refer you prior to your first appointment if you simply ask them to, and my family doctor was also able to refer me retroactively (meaning that during my first appointment through the OTN I did not know there was a cost, so to avoid being billed the hospital allowed my doctor to refer me to the service/ Dr. Blair after my initial appointment). If you do not have a family doctor or RN available to refer you, $100.00CAD is a substantial investment (this may be less or more in your community) – though this is vastly cheaper than multiple flights for appointments to Toronto, at least from my city.

5. Have your initial appointment

I believe my initial appointment was an hour to one-and-a-half hours. This time zips by, and this was genuinely one of the most affirming experiences of my life. Blair is again very kind and passionate about the care he provides for trans folks, so questions that may feel intrusive or cold from, say, a psychiatrist barring you from HRT, feels more like a discussion. He made it very clear to me at the beginning of the appointment that I was not there to “prove” my gender to him, as a lot of trans folks are expected to do within the medical system. He is non-binary, agender, bigender, and genderqueer positive (identities outside of the gender binary are not remotely an issue as they have been with organizations such as CAMH in the past). You do not have to answer anything that does not feel applicable to you or you do not know how to answer, and you can always ask for a bit more clarification on what he might be asking. He is essentially trying to get a feel for who you are, what you are wanting out of HRT, and if you’ve worked through the emotional aspects and the physical aspects (actual effects of HRT on the body), etc. You can ask any questions you would like during this appointment – effects, time frames, costs, etc. He uses an informed consent model, opposed to other models you may have encountered or heard of involving processes of navigating approval from a mental health professional and the like.

Informed consent [for medical care or treatment] is a process that includes all of these steps:

• You are told (or get information in some way) about the possible risks and benefits of the treatment
• You have the chance to ask questions and get them answered to your satisfaction
• You have had time (if needed) to discuss the plan with family or advisers
• You are able to use the information to make a decision that you think is in your own best interest
• You share your decision with your doctor or treatment team

If you’d like to email or Skype with me about what the first appointment was like, please don’t hesitate to do so. My email address is nonbinarynoise@gmail.com, or you are welcome to use the contact form on the Contact page. You should feel as comfortable as possible going in, and if having a bit more of a handle on what to expect might help with that, I’d be glad to answer any questions I can.

Your second appointment will most likely be scheduled at the end of this one – bring along your phone, day book, or a piece of paper to jot it down and make sure the time and day works for you. My appointment was at my local hospital that had a Telemedicine unit – Blair will assist in where to go in your community or close to it. Also, bring your OHIP card.

6. Carry out blood work requisition from initial appointment

You will receive a blood work requisition form from Blair prior to beginning HRT. Simply print out the requisition that is emailed to you, bring it with you to a clinic in your community (such as LifeLabs), and the clinic will send off the information to Blair for you.

7. Have your second appointment

My first appointment was on June 9th, and my second was on June 27th. This process was very quick and painless for me, which was such a refreshing and affirming change from the past two-and-a-half years of attempting to seek HRT from my hometown of Thunder Bay. My second appointment was all I needed to obtain my prescription. It was much shorter than the first appointment, but he ensured I had time to ask absolutely any additional questions I had, took some time to have a good conversation on a few aspects of the medical system related to trans care and potential reform (which was a welcomed topic of interest, aha), and allowed me to spend some time being silent to just think and process through the emotions I was experiencing. I was hopeful, I was relieved, I was exhausted, I was excited beyond belief but also so, so calm – he talked through these with me and let me do so in a way that felt like I was speaking with a friend I’d known for years.

8. Get your prescription faxed to your pharmacy of choice

Blair will fax your prescription over to a pharmacy you prefer or one simply near you – so just know which pharmacy would be best by name. Be aware that if you have not used a specific pharmacy before, there may be a co-pay or similar fee for using it initially during that calendar year. Call ahead to avoid any issues. My pharmacy was out of what was required to conjure up a 60 metered-dose pump of Androgel, so I had to wait until noon the next day to pick it up. You will discuss with Blair the costs of various methods – topical (Androgel Gel) is relatively expensive compared to injectable (vial and syringe), but made more sense for me due to the fact that measuring out such a small dose (only 10mg a week to start) would be difficult with a syringe but very easy with the gel. One bottle of the gel came to about $90.00 CAD without insurance, which is rather pricey for anyone who would require or is seeking a higher dose. I will most likely switch to injectable once I find a dosage that feels right for me and this bottle is done – though that decreases cost significantly, now injection is an added part of that equation that rubbing gel on my skin did not involve. Ask absolutely any dosage or cost questions you would like to in your meeting(s) with Blair.

9. Keep in contact with your family doctor (if applicable), and keep in whatever contact with Blair that you’d like outside of dosage changes, etc.

Blair makes himself as available as he can for any questions or concerns patients may have. You can request appointments with him if you feel you need them, but after receiving my prescription I was emailed another blood work requisition and told to have that done after one month of HRT, and schedule an appointment with him if I felt so inclined (which I will do as I will most likely want to increase my dose at this time). Let your family doctor or routine RN know what is going on if applicable. I had to sign a consent form for Blair to share medical information with my family doctor – you’ll be told if any of this needs to be done. Blair has been in contact with my family doctor to get her a bit more up to speed on assisting/ monitoring someone beginning HRT, though he is my main contact to discuss blood work, changes in dose, and the like.

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References

What is informed consent and what does it mean? (2014, July 28). Retrieved August 2, 2015, from http://www.cancer.org/treatment/findingandpayingfortreatment/understandingfinancialandlegalmatters/informedconsent/informed-consent-what-is-informed-consent