Find out more about trans health in Nova Scotia, including:
- Information on a community consultation held in January 2014
- The April 1, 2014 announcement to cover surgeries in Nova Scotia
- Information on gaining approval for gender confirming surgeries in Nova Scotia
What does the community want?
The forum was held to address the development and implementation of policies for the coverage of sexual reassignment surgeries (SRS) [also known as gender confirming surgeries (GCS), gender affirming surgeries (GAS) and/or gender reassignment surgeries (GRS)]. It was our intention to create a space for those who will be affected by these policies and their implementation to have conversations and make recommendations.
You can now download the final report from that event here: Report-Trans Community Forum on SRS Implementation [PDF].
Gender Confirming Surgeries in Nova Scotia
On April 1, 2014, the Department of Health and Wellness announced that eight (8) different types of surgeries. While we applaud this important step, we still have concerns and see room for improvement (see our media release). There has been some confusion and lack of clarity surrounding processes and surgical options.
One particular area of concern was chest surgeries and whether this will meet the chest masculinization needs of transmen. As of April 9th, the Department of Health and Wellness has released a revised Implementation of Funding for Sex Reassignment Surgery (April 9, 2014). See our statement of clarification: Clarification on Gender Confirming Surgeries. The province will cover mastectomies that create a chest that more closely resembles a male chest, they will not cover chest masculinization and/or chest contouring (which typically involve liposuction and implants).
There are still many hurdles to overcome and further clarification needed. We hope to work together with community members, the Department of Health and Wellness, partner organizations, and service providers to continue to clarify what these changes mean and to help improve healthcare for transgender Nova Scotians.
Approvals for Gender Confirming Surgeries
The Nova Scotia Medical Services Insurance Plan (MSI) has a requirement that any referrals for out of province procedures must be made by a specialist (i.e. a Medical Doctor with an additional specialization, for example a surgeon, a psychiatrist or an endocrinologist). This rule is being applied to people requiring gender confirming surgeries.
The Department of Health and Wellness (“DHW”) had previously announced that criteria for approval of gender confirming surgeries would be based on World Professional Association for Transgender Health (WPATH) Standards of Care Version 7 (“SOC 7”). The MSI specialist requirement has created an additional approval step, above the requirements of SOC 7. The largest impact of this will likely be on those seeking chest reconstruction surgery (top surgery), since under SOC 7 only one referral letter is required, and this could have come from a trained clinical social worker. There may be less impact on those seeking one of the genital surgeries, as SOC 7 already had a requirement for two referral letters for these procedures, one of which was already likely to come from a specialist.
NSRAP has expressed our disagreement and concern with the inclusion of requirements above those specified in SOC 7, and the additional barriers and delays that this creates. It is our position that the approval criteria should be based upon the criteria laid out in SOC 7, and that if MSI requires “specialist approval”, then, in the case of gender confirming surgeries, those trained in SOC 7 should be viewed as the specialists.
We are continuing to follow up with the Department of Health and Wellness to attempt to address this situation, however we caution community members who may be requiring surgeries that the outcome of these discussions is uncertain. It is important that those looking to access these services be aware of the current requirements and we recommend working towards meeting the requirements as they currently stand (ie obtaining a referral from a specialist), while we also continue to work towards change.
Attached is a DHW checklist showing the current requirements. Pride Health may be able to assist in navigating the referral and approval process: SRS Approval Request Form [PDF]