Transgender patients are driving change within Saskatchewan’s medical community, according to a Saskatoon family physician who specializes in trans care.

“When you see a need in your patients or in the community, you work toward filling that need,” said Dr. Leane Pask, who practices at the Saskatoon Community Clinic. “More people are feeling safe to come out and to get care, which is also a reflection of some improvements in the medical community on a basic level of being trans aware,” she said. “Physicians recognize the importance of providing culturally competent care, such as using preferred names and pronouns. More people are feeling safe to access health care and they know that there are medical options available to them.”

Dr. Pask reflected on recent changes to trans health care as Pride Month activities wrap up in Saskatchewan. Progress has been slow and steady, but care has improved for people seeking hormone replacement therapy or gender-affirmation surgery, she said.

“I feel we have accomplished a lot, but as things evolve you always pick out what’s the next step, how can we improve things further? There doesn’t seem to be a stopping point; it can always be better.”

Hormonal care

Prior to the COVID-19 pandemic, a group that included physicians, researchers, people from the trans community and advocacy groups, and patients met monthly to try to improve trans care in Saskatchewan. The pandemic put a stop to those meeting, but the group – the Saskatchewan Trans Health Coalition – developed the Saskatchewan Medical Transition Guide. Dr. Pask notes the guide is Saskatchewan-specific and is a useful resource for physicians.

She said physicians should also be aware two trans navigators have been hired as part of a year-long research project by the University of Saskatchewan’s Academic Family Medicine and the School of Rehabilitation Science. One has been assigned to Saskatoon and northern Saskatchewan in collaboration with OUTSaskatoon (call Elijah at 306-966-5082 or email navigator.saskatoon@usask.ca), and one to Regina and southern Saskatchewan with UR Pride (call Ken at 306-337-3831 or email navigator.regina@usask.ca).

The goal is to provide support and improve the health-care experience for trans and gender diverse people, said Ken, the Regina navigator. He said the positions are making a difference.

“Navigating health care is very challenging for trans people in the province. Our positions have only been running since April but are already very busy. We can already see that as trans navigators, we are filling a big gap,” he said. “As trans navigators, we offer support to transgender individuals with health care and support needs, such as accessing hormones, surgery referrals, affirming health-care providers, support groups, resources, and name/gender marker changes,” he said.

He encourages physicians to contact the navigators for education or information. “We will answer questions physicians have about assisting trans patients, such as how to make their practice more inclusive, how to start someone on HRT, where to send referrals, or where to find trustworthy practice resources.”

Dr. Pask said permanent, stable funding for a program such as the trans navigators would be a positive development for trans care in Saskatchewan.

Another positive development is the growing interest among physicians seeking information on hormone replacement therapy, Dr. Pask said. She has trained family physicians with the West Winds Primary Health Centre in Saskatoon who are teaching medical students and residents, who in turn become more comfortable providing trans care. Some physicians want to prescribe hormones for their patients or require more expertise so that they accept referrals from other physicians. Dr. Pask has had physicians shadow her at her clinic, which gives them hands-on experience with trans care, and she also provides ongoing mentoring and contact when physicians need it.

Dr. Pask recommends interested physicians take the World Professional Association for Transgender Health’s Global Education Initiative, a two-day foundational course. Offered online during the pandemic, it is also held at locations around the world. The Saskatchewan Trans Health Coalition is hoping to bring the workshop to Saskatchewan.

Interest among physicians has had the important effect of reducing wait times for trans patients – it has saved lives, Dr. Pask said. Wait times for her personal practice was previously between 12 to 18 months. Many patients are referred to her for hormone replacement therapy. With more doctors comfortably prescribing hormones or taking on referrals, her wait times have dropped to three to six months.

“The highest suicide rate is between the time that a person decides they want to go on hormones or comes out and decides they want to go on hormones and accessing hormones. The decrease in those wait times is crucial in saving lives,” she said.

Surgical care

Five Saskatchewan physicians are now considered “recognized authorities” for approving people for out-of-province gender affirming surgeries. Some surgeries can be performed in Saskatchewan such as hysterectomies and mastectomies, but more complex procedures are not available in the province. The Ministry of Health will cover some of those out-of-province surgeries if they are recommended by a recognized authority. A few years ago, one physician was recognized by the ministry, but now there are five in Saskatchewan, including Dr. Pask, as well as four outside Saskatchewan.

“This is a significant development for people who want gender-affirmation surgeries in a timely manner,” Dr. Pask said. She added more support is needed for people who return to Saskatchewan and have complications following surgeries. Family physicians and specialists can address some of these complications, but not all of them because they lack expertise in this area of medicine. She hopes physicians are able to become educated on common problems post-surgery and better know what to do about them.

Social care

Dr. Pask points to three developments:

• eHealth has streamlined the process for people to change their name and gender marker at the same time on all Saskatchewan documents.
   
• People have been given the option of removing their gender marker completely, which is important for those who identify as non-binary, agender or two-spirit.
   
• Conversion therapy has been banned by Saskatoon city council, and a ban has been proposed in Regina.