Ontario Health’s Gender-Affirming Care for Gender-Diverse People: Care for Adults quality standard addresses care for gender-diverse adults aged 18
years and older. The quality standard focuses on gender-affirming care and the
primary care needs of gender-diverse people, including assessment, screening,
treatment, and follow-up. It addresses referral for gender-affirming surgery,
based on clinical evidence, but not specific surgical procedures.
Although many statements may apply to intersex people, this
quality standard does not directly address the care of intersex people.
Significant opportunities exist to improve gender-affirming
care in Ontario. This quality standard includes five quality statements that
address areas identified by the Gender-Affirming Care for Gender-Diverse People
Quality Standard Advisory Committee as having high potential to improve care
for Two-Spirit, trans and nonbinary people in Ontario.
Below is a sample of tools that may help you implement the
quality statements in practice, organized by purpose. Many of these tools will
help support multiple quality statements.
This list is not exhaustive, and these may resources have
recognized shortcomings—some of which are noted here. Are there other tools or
resources you use? Do you have experience implementing these or other tools? If
so, please share your thoughts in the comments section below.
Education Resources for Clinicians
On Clinical Competence:
- Primary Health Care for Trans Clients: A comprehensive guide for primary care clinicians on
care for trans and gender-diverse clients by Sherbourne Health and Rainbow
Health Ontario. Includes an overview of trans health issues, terminology, assessment
of newly transitioning clients, and clinical guidance on providing hormone
therapy.
- 2SLGBTQ Health Connect: An online learning platform with low-cost, on-demand and
facilitated virtual courses to help clinicians build competence in providing gender-affirming
care by Rainbow Health Ontario. CME-accredited course offerings include topics such
as transitioning, transition-related hormone therapy, feminizing and
masculinizing surgeries, post-operative care, trauma-informed care, autism and
gender identity, and more.
- Trans Health Mentorship Call: A teleconference twice per month for Ontario
clinicians to connect with peers who have experience caring for trans and
non-binary service users, facilitated by Rainbow Health Ontario. Open to any
professional (physician, nurse, social worker, mental health worker, etc.) who
is or will be working with trans and non-binary service users.
- 2SLGBTQ+ Education Program: A free, 4-module, self-paced online learning program
designed for medical students by the Canadian Queen Medical Students
Association. Topics covered include general 2SLGBTQ+ knowledge, bias and
advocacy, queer health care needs and key skills for providing inclusive care.
- eConsult Ontario: A secure web-based tool that allows primary care clinicians timely
access to specialists, including those with expertise in gender-affirming care,
often eliminating the need for an in-person specialist visit.
On inclusiveness and cultural humility:
- Sexual Orientation and Gender Identity in Nursing Toolkit: A free, interactive
e-learning program for health care providers by the Canadian Alliance of Nurse
Educators Using Simulation. Features virtual simulation games in different settings
(emergency department, community care, etc.) to demonstrate inclusive
interactions and cultural humility in providing care to 2SLGBTQIA+ people.
- Indigenous gender diversity: creating culturally relevant and gender-affirming services:
A 3-hour foundational course for people working in health care, mental health,
and social service settings to help learners increase awareness, knowledge, and
skills for improving access to services for gender diverse Indigenous people by
Trans Care BC and the Provincial Health Services Authority Learning Hub (British
Columbia).
Tools and Resources to Support Clinical Practice
- Guidelines for gender-affirming primary care for trans and non-binary patients: A quick reference guide for primary care providers: A 6-page summary of transition-related
hormone protocols by Sherbourne Health and Rainbow Health Ontario. Includes information
on estrogen and testosterone formulations, dosages, costs, effects and expected
time courses, monitoring, dosage adjustments and precautions.
- Reproductive Options for Trans People: A 9-page evidence brief on reproduction options
for gender-diverse people interested in hormone therapy or surgeries by Rainbow
Health Ontario, the Centre for Addiction and Mental Health, and others. Addresses
fertility preservation, breastfeeding, contraception, hysterectomy and chest
surgery, egg/embryo/sperm freezing and costs, and fertility preservation for
prepubescent children.
- Tips for Providing Pap Tests to Trans Men: A 1-page resource for primary care
clinicians that outlines six important considerations when providing pap tests
to trans men by Rainbow Health Ontario.
- Overarching Policy for the Screening of Trans People in the Ontario Breast Screening Program and the Ontario Cervical Screening Program: A policy that outlines
evidence-informed screening recommendations for trans and nonbinary people by
Cancer Care Ontario.
- Transition-Related Surgical Summary Sheets: A 29-page resource for primary care clinicians to
facilitate discussions with patients interested in breast augmentation, chest
reconstruction, clitoral release, hysterectomy and bilateral
salpingo-oophorectomy, metoidioplasty, orchiectomy, phalloplasty, or
vaginoplasty. Includes details on surgical techniques and options, intended
results, side effects, risks and complications, and pre- and post-operative
care.
- Referral Template for Gender-Affirming Surgery: A downloadable, editable example of
a referral template for transition-related surgery by Women’s College Hospital.
Tools and Resources to Support a Gender-Affirming
Environment
Tools and Resources to Support Gender-Diverse People
- Trans Health Knowledge Base: A database of frequently asked questions on trans
health for gender-diverse people aged 18 and above by Rainbow Health Ontario.
Provides information on topics such as
changing names and/or sex markers on government-issued identification, finding an affirming health care provider or counsellor,
funding for transition-related surgeries, how having a mental health diagnosis other than gender dysphoria may affect care,
and many more.
- Service Provider Directory: A searchable directory of health and social service
providers who have expressed a commitment to providing gender-affirming care,
maintained by Rainbow Health Ontario. Note: Rainbow Health Ontario is not able
to screen the service providers listed in this directory or guarantee the
quality of their services.
- FAQ: Transition-Related Hormone Therapy: A 3-page informational resource that
answers questions people commonly ask about starting transition-related hormone
therapy by Rainbow Health Ontario. Includes brief descriptions of feminizing
and masculinizing hormone therapies, their impacts, how to access them, and
coverage under provincial drug benefit plans.
- Estrogen-Based Hormone Therapy: A webpage that outlines various options for estrogen-based
hormone therapies and associated advantages and disadvantages of each, as well
as expected effects, timeframes and risks by Trans Care BC.
- Testosterone-Based Hormone Therapy: A webpage that outlines various options for testosterone-based
hormone therapies and associated advantages and disadvantages of each, as well
as expected effects, timeframes and risks by Trans Care BC.
- How to Inject Hormones : A webpage with information for people who inject transition-related
hormones by Trans Care BC. Includes links to illustrated pamphlets with
step-by-step instructions on
safer intramuscular injections and safer subcutaneous injections.
- A Guide to Self-Administering Intramuscular or Subcutaneous Injections: an infographic on injecting hormones that includes information about where to find supplies for safe injection, available from Rainbow Health Ontario.
- Surgery: A
website by Trans Care BC with information how to access, prepare for and
recover from common transition-related surgeries, including
breast construction, removal of testes, vagina and vulva construction, chest reduction and construction, uterus and ovaries removal, and penis construction.
- FAQ: Transition-Related Surgery (TRS): A 5-page informational resource that
answers questions people commonly ask about transition-related surgeries by
Sherbourne Health, Rainbow Health Ontario, and others.
- Sexual Health:
Webpages available on the Foria Clinic website with information on sexual
health for
people assigned male at birth, people assigned female at birth, and those who have undergone vaginoplasty,
metoidioplasty
or phalloplasty.
Additional Resources