Exploring Gender Identity: Navigating a Medical Transition
Transitioning looks different for everyone. Some people will navigate through a social transition to feel affirmed in their identity, while others will also navigate through a medical transition. There is no right or wrong way to explore one’s gender identity. Finding what works for you and what helps you feel affirmed in your identity is what is most important.
Social transition: This includes changes such as: changing your name or pronouns, coming out to family and friends, dressing or grooming in a different way, and/or wearing gender affirming gear.
Medical transition: This includes changes such as: starting medically supportive treatments such as hormone therapy and/or undergoing surgery such as top or bottom surgery.
If you had an opportunity to read the first article in this series, you would have learned about navigating a social transition (if you haven’t had a chance to read this article, check it out here: www.wellness.mcmaster.ca/exploring-gender-identity-social-transitioning
In this part of the series, we will be discussing the different considerations for a medical transition.
Reminder: You do not have to transition physically for your identity to be valid!
Some considerations for a medical transition can include:
- Starting medically supportive treatments such as hormone replacement therapy
- Undergoing gender affirming surgery such as top or bottom surgery
Hormone Replacement Therapy (HRT)
HRT is a medically supportive treatment that can be prescribed by a primary healthcare provider.
Feminizing HRT supresses androgens (testosterone) and provides additional estrogen. This reduces the endogenous effects of testosterone (e.g., reducing the likelihood of masculine sex characteristics such as facial hair), and induces feminine secondary sex characteristics such as breast and hip development. Common side effects of feminizing HRT include fatigue, and emotional changes. Note: mood and emotional side effects are often temporary.
Masculinizing HRT provides additional testosterone which induces masculine secondary sex characteristics (such as facial hair and changes to muscle mass). Common side effects of masculinizing HRT include acne, genital dryness, and mood changes. Note: mood changes are often temporary.
Something to consider prior to starting HRT is whether you may want biological children in the future as HRT may reduce your fertility. If HRT is right for you, you may consider freezing your sperm/egg or embryo.
Note: There are some risks associated with HRT, especially for those who have underlying medical conditions or who smoke. However, most people can safely take HRT. Talk to your healthcare provider to see if HRT is right for you.
Gender Affirming Surgery
In Ontario, there are some gender-affirming surgeries that are covered by OHIP (Ontario Health Insurance Plan), and there are also a few other surgeries that are not covered and would have to be paid for out-of-pocket.
Funded by OHIP
Top surgery, and bottom surgery are gender affirming surgeries that are covered by OHIP.
Top surgery (the removal of breast or chest tissue): Requires one assessment from a medical provider confirming persistent gender dysphoria.
Bottom surgery (including vaginoplasty, phalloplasty and metoidioplasty): Requires two assessments- one from a medical provider, and a second from another medical provider or a registered psychologist or social worker involved in your care.
Note: OHIP doesn’t cover travel or accommodation costs to obtain gender-affirming surgery.
Not Funded by OHIP
Other surgeries that may be gender affirming for some include:
- Adam’s apple shaving
- Facial feminization/masculinization
- LASER hair removal
- Hair transplants
- Surgeries solely for the purpose of altering one’s appearance
These surgeries are not covered by OHIP and would be paid for out-of-pocket.
Some things to consider before looking into gender-affirming surgery would be the cost and location of surgeries (as some trans related surgeries are not performed in Ontario), and finding competent, inclusive and welcoming medical service providers.
Finding the Right Healthcare Provider
If you are currently a student at McMaster, and you are living in the Hamilton area, you can also make an appointment at the Student Wellness Centre (SWC) on campus. The SWC offers gender-affirming care options such as:
- Documentation and letters
To speak with a healthcare provider, call 905-525- 9140 ext. 27700 and book an appointment.