Barriers to care persist as Winnipeg gender transition clinics hope to chip away at backlogs

WARNING: This story contains discussion of suicide. 

Elisha Dacey’s 15-year-old is caught in a care gap: too old to be accepted at one gender transition Winnipeg clinic, too young to get in at another.

“They were right in that sweet spot of technically not getting or qualifying for any kind of public health, so that was frustrating and demoralizing,” said Dacey. “Since then we’ve still been just waiting.”

The Gender Diversity Affirmation and Action for Youth clinic (GDAAY) helps children and young teens transition.

It used to help patients up to the age of 15, but has reduced the age referral criteria by one year to 14.

That was in  response to demand outpacing resources “owing to the fact that we are entirely unfunded,” reads a GDAAY doctor’s letter to Dacey’s child’s pediatrician in April of this year.

The Trans Health Klinic, the only other program in the city, helps people 16 and up transition. Dacey was recently informed their child is now on that waitlist.

They join the roughly 600 other youth and adults who remain in waitlist limbo amid a shortage of care providers outside the two clinics trained in gender-affirming care.

“That’s a huge barrier unto itself is just the lack of professionals who are dealing specially in this,” said Dacey.

“I want to see that funding become permanent … I’d like to see it basically removed from ideological lines. It’s healthcare.”

A teen and their mom pose for a selfie.
Elisha Dacey, right, and their 15-year-old. The teen is one of a number of Manitobans who have encountered barriers to gender-affirming care in the province. Some health-care workers say they hope this will improve as funding to reduce wait times announced in spring by the province starts to be put to use. (Elisha Dacey)

Years-old waitlist challenge

The clinics offer a range of services, from counselling and mental health-care to hormone replacement therapy and gender-affirming surgeries.

Intake is a multi-level process and the entire process can span years. 

Many patients come from referrals from family doctors and each clinic has struggled to keep pace with demand.

The annual number of consultations has tripled at GDAAY. Nearly two dozen youth sought consultations the year GDAAY opened in 2011, and that number has increased to about 75 per year, according to a statement from Shared Health, the entity overseeing the delivery of healthcare in Manitoba. 

Shared Health attributes that to increased awareness about transgender issues, a rise in gay-straight alliances and a focus on reduced bullying in schools.

Currently, there are nearly 300 youth on the GDAAY waitlist and it’s an average two-year wait. It’s a similar number of patients on the Trans Health Klinic waitlist, which averages a 1½-year wait.

Dr. Brandy Wicklow, the medical lead of GDAAY, co-authored a scientific paper in 2018 based on work with child patients at GDAAY that suggested trans youth seeking services faced distress “over long wait times.”

Spring funding boon to programs

In May, the province committed $1.2 million over two years to help the two clinics improve access to care for transitioning youth, including hormone replacement therapy medication, psychological supports and surgeries.

Staff with each program were encouraged to hear the news.

A physician sitting at the desk in their office poses for the camera.
Megan Cooney, a pediatrician and adult medicine specialist with Manitoba’s Shared Health, has been working with the Gender Diversity Affirmation and Action for Youth program. (Bryce Hoye/CBC)

“It’s been challenging to work in this system knowing that the waitlist is as long as it is,” said Dr. Megan Cooney, a pediatrician and adolescent medicine specialist with Shared Health who has worked with GDAAY for five years.

“What we’re most looking forward to with the program expansion is actually being able to provide more support to families on the waitlist.”

The Progressive Conservative government provided $490,000 to Klinic Community Health Centre, which runs the Trans Health Klinic, and $700,000 to expand access to GDAAY, according to a news release that was quickly removed from the government’s website.

Up until this spring, the pediatricians, endocrinologists, mental health experts and others who have staffed GDAAY have done so through an “in kind” agreement with their employer — essentially, doing the work off the sides of their desks while managing other general duties because the program has never been formally funded.

The funding enables GDAAY to hire dedicated staff for the first time, including an administrative assistant, a program co-ordinator, a part-time social worker and a full-time child psychologist.

A woman in a blue blazer speaks behind the microphone at a news conference, while two other people stand behind them.
Manitoba Premier Heather Stefanson, flanked by Pride Winnipeg president Barry Karlenzig and Families Minister Rochelle Squires, took part in a government announcement on May 23 on various LGBTQ initiatives, but made no mention about a new commitment for gender-affirming care that was included in a background document that same day. The government deleted any reference to the commitment from its website, then responded saying a ‘future update’ was coming. (Ian Froese/CBC)

Cooney said the gap between 14 and 16 is something GDAAY is “hoping to be able to fill again” once they have staff in place.

The clinic tries to pair up kids and their families with a social worker while they wait, though Cooney acknowledged the stakes are high for kids who can’t get the help they need.

“Specifically gender-affirming hormone medications, when they’re indicated, they improve health and wellness and they decrease suicidality,” said Dr. Cooney.

WATCH | GDAAY doctor discusses importance of supporting gender diverse youth:

Access to transition care can ‘improve the lives of many youth in our community’: doctor

Dr. Megan Cooney, a pediatrician and adolescent medicine specialist with Shared Health who works at GDAAY, said gender-affirming care that’s offered “in a safe and effective way has the potential to improve the lives of many youth in our community.”

Haran Vijayanathan, community health and wellness director at the Trans Health Klinic, said trans and gender diverse youth face higher risks of mental health challenges and suicide, particularly when they don’t have supportive people in their lives.

Long waitlists add another layer.

“That’s often a huge challenge for individuals, especially when they’ve come out to themselves and they’re comfortable with who they are,” he said. “There’s a lot of psychological and emotional trauma that they’re experiencing because that process hasn’t started.”

A person in a yellow sweater takes a selfie against a brick wall in the background.
Parker Morran says they are the first social worker hired at Klinic Community Health’s Trans Health Klinic. They were hired in the past few months as a result of $490,000 in funding from the province announced in May. (Parker Morran)

Vijayanathan said the two-year funding commitment has helped the clinic boost staffing with four more peer support workers and the first social worker at Klinic dedicated to trans care. But what’s needed to keep the momentum going is “sustained” funding year over year, said Vijayanathan.

Dacey agrees. “I want to see that funding become permanent … I’d like to see it basically removed from ideological lines. It’s healthcare,” Dacey said. 

In the meantime, Parker Morran is hoping to have an impact as that new dedicated social worker at Trans Health Klinic.

They’re one of the first points of contact for many who come through.

“My job is kind of a dream job; I get to hang out with trans people every day,” said Morran, who is also trans and genderfluid. “I can relate to the people I meet with on that level because I’ve done it.”

They said they waited eight months about a year and a half ago to get into Trans Health Klinic for their own transition care. Morran is now on hormone replacement therapy — testosterone specifically — and midway through another public health list for top surgery. It has an estimated two-year wait, they said.

They said getting on the lists comes with excitement in knowing the wheels are in motion. That’s contrasted against the “limbo” of waiting.

“It’s not fair to have to ask people to wait, really. It would be nice to be able to just call, register and make an appointment in a few months or less,” they said.

Morran wishes gender-affirming health care was more of a priority in the health system. 

“But I am glad for the progress that has been made in the last little while.”

WATCH | Vijayanathan on hard fought 2SLGBTQIA rights:

Long waits for gender-affirming care ‘huge challenge’

Haran Vijayanathan, community health and wellness director at the Trans Health Klinic, the lack of a support network can make the long waits for access to gender-affirming transition care even harder.

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