How Alberta Health Services (AHS), psychiatrists, psychologists, and medical doctors relate to trans people in terms of access to hormone replacement therapy (HRT) and surgery is based on best practices recommended by the World Professional Organization for Transgender Health (WPATH) Standards of Care (2012). WPATH is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, advocacy, public policy, and respect for transgender health. WPATH publishes the Standards of Care, which provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment. For more information, visit www.wpath.org.
The “Real Life Experience” (RLE) (also known as “living full time” or “the real life test”) is a term used in the medical world to describe a period of time in which a transgender individual lives in the gender role congruent with their gender identity. The current Standards of Care states that RLE is not required in order to be prescribed hormones, however, twelve months RLE is required by Alberta Health Services prior to funding for genital surgeries.
The social aspects of changing one’s gender role are usually challenging – often more so than the physical aspects. The purpose of the RLE is to give individuals ample opportunity to experience life and socially adjust in their desired gender role before undergoing irreversible surgery, as well as to give them awareness of what the familial, interpersonal, educational, vocational, economic, and legal challenges are likely to be, so that they can function successfully in their gender role.
The duration of 12 months allows for a range of different life experiences and events that may occur throughout the year (e.g., family events, holidays, vacations, season-specific work or school experiences). Support from a qualified mental health professional and from peers can be invaluable in ensuring the transition process feels right for the individual.
Living full-time as the gender with which you identify doesn’t necessarily mean conforming to stereotypes of femininity or masculinity, or “passing” for being non-trans. It’s about manifesting your gender identity as you define it, moving from thinking or dreaming about how you want to express your gender to actually doing it.
The RLE entails presenting consistently, on a day-to-day basis and across all settings of life, as your desired gender role. This can include using a name and gender pronoun that is consistent with your gender identity, legally changing your name, having an appearance (clothes, hairstyle, etc.) that is consistent with your gender identity, people in your day-to-day life—friends, partner(s), co-workers, teachers, etc.—knowing you in your desired gender role (they don’t need to know that you’re trans), and coming out to partners, family, friends, and community members who already know you (e.g., at school, work, other settings). In some situations, health professionals may require verification that this criterion has been fulfilled, e.g., for recommendations for surgery.
Other than the obvious benefit of having a trans friendly doctor, having a doctor who is knowledgeable about trans people can be very helpful if you are pursuing surgery or hormone replacement therapy (HRT).
In Alberta, the practice of medicine is governed by the College of Physicians and Surgeons of Alberta. If you are looking for a General Practitioner (family doctor) who is accepting patients at this time and is open to seeing trans patients, you can put in a request to them, and they will do their best to locate one. Finding a doctor who is accepting new patients can sometimes be difficult, and because many of those who are accepting new patients often are uncomfortable or feel that they don’t have adequate training for working with trans people, it may be difficult to locate one in your area. You can call the College of Physicians and Surgeons toll-free at 1-800-561-3899 or you can email them at publicinquiries@cpsa.ab.ca. If you have a complaint about a physician, there is an additional toll free number at 1-800-661-4689.
Some doctors in the Lethbridge area are known to be trans-friendly and knowledgeable. Some of them are even known to prioritize trans patients if they know you are trans when you make your inquiry. Disclosing your identity might be helpful in getting an appointment. Please refer to the queer-affirming doctor tab in Appendix B for potential trans-friendly doctors or:
- Place an inquiry on Alberta Trans Peer Support Network
- Inquire with the physicians listen in the queer-affirming doctors tab in Appendix B
If you are under 25 years of age and can get to Calgary, the Alex Youth Health Centre is a trans-friendly clinic providing medical and counselling services. It is located at 2840 2nd Ave SE and is open Monday to Friday, 12:00 noon – 6:00 pm. The Alex Youth Health Centre may be reached by phone at 1-403-520-6270, by text at 1-403-680-9627, or by email at youthinfo@thealex.ca. Doctors at this clinic can refer people to other community services in Calgary, including gender psychiatrists, and the Metta Clinic. The Metta Clinic is dedicated to comprehensive health care for transgender youth, and includes access to mental health and peer support services, puberty suppressors and other hormone replacement therapy drugs.
Some people have found that when they disclose their trans status to their current doctor, sometimes the doctor is willing to learn about trans health issues and will continue as their doctor. In these cases, it is helpful if you as the patient can provide information to assist the doctor in becoming more knowledgeable. A good source of information is the Guidelines and Protocols for Hormone Therapy and Primary Health Care for Trans Clients from the Sherbourne Health Centre in Toronto, available online.
Additional information is available here.
The skill and experience of doctors with trans communities varies greatly, and if you are not happy with the service you are receiving, switching doctors is an option.
Occasionally, non queer-affirming health care providers may perpetuate the toxic ideology of the “trans broken arm syndrome”. This is when medical professionals attribute medical concerns to an individual being trans, despite the medical concerns being unrelated to a person’s experience with hormones or identity. If you find that your doctor is not taking your medical concerns seriously or if a health care provider treats you in a way you consider discriminatory, you have every right to make a complaint and get support. Information about complaints can be found here.
In order for an Alberta resident to be approved for trans-related surgeries (top surgery, hysterectomy, and Gender Affirming Surgery), and receive funding from AHS, you must be assessed by one of four psychiatrists in Alberta who support transgender clients. Two of these, Dr. Lorne Warneke and Dr. Justin Petryk, are located in Edmonton and no longer accept referrals for Calgary individuals. All Calgary and area residents are currently referred to either Dr. Raiche or Dr. Gibbs.
*Important: A referral is necessary to access these two psychiatrists. Do not contact their offices unless you have already been referred and are confirming your referral or looking to communicate for reasons other than a referral. Contact information for these psychiatrists is provided here to assist your doctor in making a referral.
Dr. Joe Raiche
South Tower, 7th Floor, Room 703
Foothills Medical Centre
1403 29 St NW, Calgary AB
Phone: 1-403-944-5872
Fax: 1-403-944-2409
Dr. David Gibbs
Calgary Sexual Health Centre
301 14 St NW, Calgary, AB
Phone: 1-403-283-5580
Fax: 1-403-270-3209
To get an appointment with Dr. Raiche or Dr. Gibbs, you will need a referral from your family doctor or a doctor at the Alex Youth Health Centre. If you don’t have a family doctor, a walk-in clinic doctor may be able refer you. In some cases it may also be possible to get a referral from a psychologist or another psychiatrist. The counsellors at the Calgary Sexual Health Centre are also able to provide referrals to both Dr. Raiche and Dr. Gibbs. It’s a good idea to give the gender psychiatrist’s office a call, two or three weeks after your doctor sends the referral, to confirm that the referral was received.
Unfortunately, the wait time for an appointment with the gender psychiatrists typically exceeds a year, so trans and questioning individuals are encouraged to ask their family doctor for a referral as soon as possible. If you change your mind, you can always cancel or postpone your appointment, but if you delay making an appointment until you are sure you want to transition, you will then have a long wait for an appointment. Once you have an appointment, you will typically have a series of meetings with the psychiatrist to enable them to confirm an assessment of gender dysphoria.
Following an assessment of gender dysphoria by these psychiatrists, they can provide referrals for top surgery and hysterectomy (for transmasculine individuals), referrals to endocrinologists for Hormone Replacement Therapy (HRT), and referrals to the voice clinic in Lethbridge. They can also provide letters to enable a change of gender marker on birth certificates and identification. As mentioned above, in order to access gender affirming surgeries (GAS or genital surgeries), individuals will be required to have lived full time in their affirmed gender role for a minimum of one year. In the medical world this is called the Real Life Experience (RLE) and is a set standard mandated by AHS based on the WPATH Standards of Care. Following the RLE, your psychiatrist will refer you for a second opinion by another psychiatrist. Once the two psychiatrists feel that you have fulfilled all the requirements for a referral for GAS (based on the WPATH Standards of Care), they will then make a recommendation for funding for GAS surgery to AHS and a referral to the clinic in Montreal (Centre Métropolitain de Chirurgie). Note that this clinic is currently the only clinic for which AHS will provide funding for surgery.