For trans people in New Brunswick, inclusive health care isn’t guaranteed

This article is the second in a two-part series about Clinic 554 and health care in New Brunswick.

Clinic 554 is currently the only health centre in New Brunswick where trans people know they can go to receive informed, inclusive care. Now that it’s closing, they’re being forced to contend with a medical system they say doesn’t prioritize them.

Advocates for Clinic 554, an independent health centre in Fredericton, N.B., are currently pleading with the provincial government to save the clinic because of its accessible abortion care. Losing the clinic would also mean losing the province’s foremost resource for trans New Brunswickers.

Slated to close at the end of September, Clinic 554 provides a range of services, including abortions, standard check-ups, and LGBTQ2S+ focused care.

For trans patients, Clinic 554 offers an informed consent model of care, meaning clients can self-refer for gender-affirming services at the clinic without requiring a recommendation from a mental health specialist, which many family doctors still request across the province.

If someone wants to transition—take hormones or undergo other medical treatments to help affirm their gender identity—all they have to do is make a phone call.

In late 2015, Anna Wyllie, who had been questioning her gender identity for a few years, decided to explore transitioning with the help of a doctor. Friends of hers who were also transgender told her about Clinic 554 and its informed consent model for trans patients.

Wyllie booked her first appointment at Clinic 554 in Feb. 2016 to talk about accessing gender-affirming care. She remembers appreciating the welcoming environment at the clinic, from the therapy dogs in the waiting room to the staff’s positive attitude.

“I was so nervous at first,” she told The Pigeon in an interview. “But I remember the first time I talked to Adrian [Edgar], I thought he was very kind and warm.”

During the appointment, Wyllie expressed some uncertainty about starting to medically transition right away. She said that Dr. Adrian Edgar—who owns and operates Clinic 554 with his partner, Valerie Edelman—recommended that she go to a therapist first to talk about her fears and gender identity.

“I talked through my concerns and my uncertainties [with a therapist],” she explained. “After a few months in therapy [I realized], ‘Yes, I definitely do want to transition,’ so I went back to Clinic 554.”

Throughout the process of her transition—which, for Wyllie, included starting hormone replacement therapy (HRT)—the staff at Clinic 554 carefully monitored both her hormone levels and overall health.

“People have this idea of informed consent clinics recklessly putting people on hormones […] but, really, Clinic 554 was always very helpful,” she said. “It was an active, informed process the whole way.”

Four years later, Wyllie’s hormone doses are at the appropriate level for her needs. She only visits Clinic 554 a few times a year to check in.

Now that Clinic 554 is closing, however, Wyllie needs to switch her transition-related care to her primary health care provider. She said he’s expressed some uncertainty about letting Wyllie continue hormone therapy.

After four years of receiving nothing but affirming care from her team at Clinic 554, having her needs questioned by her family doctor was dismaying.

“I had to get Dr. Edgar to write a recommendation letter to my family doctor earlier this summer [so I could continue HRT],” she said. “My family doctor said that unless he gets approval from Dr. Edgar to stay on [hormones] that he would not keep me on them.”

“Losing [Clinic 554], I’m realizing how great of an opportunity I had,” she said. “I could walk into this clinic and have a path laid out for me. Now, having to navigate this with a family doctor […] there’s a lot of ignorance.”

Wyllie isn’t looking forward to discussing her transition with a doctor less informed about trans health, but she feels lucky to have a family doctor at all. For many patients of Clinic 554, the facility’s closure will leave them without a primary health care provider.

“[Clinic 554] is a family doctor for thousands of people. It’s not just an abortion clinic, it’s not just a trans healthcare clinic,” she said.

“When I would sit in the waiting room there, I would be sitting next to people who were waiting for run-of-the-mill [care].”

Clinic 554, in downtown Fredericton. Photo by: Alex Dascalu

Although she has a supportive family doctor, Erica Feltford, who lives in Fredericton, doesn’t think she would have transitioned without the support of Clinic 554. Before coming out as trans, Feltford said her mental and physical health was suffering.

“[Before transitioning] I didn’t care about myself. And so, I let things go, and I didn’t worry about things, and I didn’t see [a future],” Feltford said. “I was just floundering.”

After learning that there was a local clinic welcoming to LGBTQ2S+ patients and offering trans health care with an informed consent model, she started to think about transitioning.  

“When I first reached out to [Clinic] 554, I was 38,” Feltford said. “Just knowing that there was a place for queer people in town was a really important step in my journey.”

Her first appointment at Clinic 554 was overwhelmingly positive.

“When I arrived at the clinic, I was confronted with community, welcoming, open help, and no preconceptions,” she said. “I could just go to Clinic 554, tell them that I’m trans, and start getting trans health care.”

Dr. Edgar and the staff at Clinic 554 not only helped Feltford to begin gender-affirming care, but recognized other health problems she hadn’t addressed. Soon after, she began treatment for a heart condition and two mental health conditions alongside her transition.

“When I left that first day, I had connections to services that I would need, that ultimately saved me thousands and thousands of dollars,” she said. “I had a plan in place to look at my total health situation.”

“I left feeling like a completely new person, and all I had done was go to this one place that specializes in trans health care.”

Feltford said the provincial government’s lack of action towards financially supporting Clinic 554’s abortion services will have a negative impact on all the clinic’s patients.

“This is about so much more than abortion, and by focusing on the abortion aspect, they’re causing harm to so many people who don’t even have a connection to abortion services.”

“When the pandemic happened, Blaine Higgs asked every New Brunswicker to step up for [their] New Brunswick,” Feltford said. “They need to step up [and realize] it’s not about them.”

Amy Otteson is a licensed psychologist in Fredericton and a member of the New Brunswick Transgender Health Network (NBTHN), an “interdisciplinary group of healthcare professionals and community partners seeking to improve services for transgender people.”

According to her, the province has historically fallen behind other parts of Canada in providing inclusive care to trans people. New Brunswick only began funding gender-affirming surgeries in June 2016.

“New Brunswick was one of the last provinces where Medicare came on board to cover gender-affirming surgery,” Otteson said. “It was quite a struggle for people to access care [and] it’s been an ongoing issue over the course of the last few years.”

When it comes to province-wide trans health care, Otteson also highlighted a lack of training for family doctors, who are often happy to help their trans patients, but aren’t sure how. Some family doctors in the province have said they don’t feel comfortable prescribing hormone therapy to trans patients because they aren’t well-informed.

Otteson noted that Clinic 554 has been helping patients and family doctors alike to understand the basics of trans-inclusive health care since it opened.

“Clinic 554 was able to fill a gap [in] the lack of training for primary care providers to deliver transgender medical treatment, specifically hormone treatments,” she said.

Once the clinic closes, Otteson hopes primary care providers across New Brunswick will be given the training they need to treat their patients.

“I would like to see the health authorities […] recognize that there’s a need for a focus on trans related health care in our province,” she said. “I would like to see the province make it a priority to provide care to trans patients—accessible care.”

In cases like Feltford’s, relying solely on her family doctor while transitioning could have been damaging.

Like Wyllie, Feltford saw a mental health counsellor before pursuing gender-affirming health care. After feeling more mentally prepared to start treatment, Feltford began using estrogen patches.

Then, about eight months into hormone therapy, Feltford recalled feeling emotionally unstable. She booked an appointment at Clinic 554 to see if something was wrong.

“We did blood work and [Dr. Edgar] thought it was a hormonal imbalance problem,” she explained. “My estrogen wasn’t being absorbed and I had blocked my testosterone completely.”

She was quickly switched to another method of hormone therapy, and her levels began balancing out soon after. Looking back on the care she received, Feltford said that without Dr. Edgar’s extensive knowledge of trans health care, she wasn’t sure her issues would have been addressed so quickly.

“I don’t feel confident that most family doctors would be able to deal with that situation.”

Now, after switching her transition-related care to her family doctor, Feltford misses Dr. Edgar’s expertise. It’s often up to her to tell her family doctor what kind of care she needs.

“I can’t get my [hormone] levels checked by anyone with knowledge anymore,” she said. “So, when I go to see my family doctor with my levels, I tell her if I think they’re good.”

For trans people living outside of Fredericton, seeking trans-inclusive health care is often difficult. Courtney Pyrke, who lives in Saint John with their partner, has had to navigate coming out as non-binary with only a family doctor as their health resource.

“I didn’t seek out [health] services right away, because I knew there wasn’t anything available,” they said. “The idea of [talking to a doctor] while also trying to come out to family and friends [was] too much for me to deal with.”

Recently, Pyrke approached their family doctor to ask about getting an “X” gender marker on their driver’s license, which New Brunswick has allowed since May 2019, they were met with confusion.

“I could tell from talking to her that she really didn’t know anything about [non-binary people],” they explained. “The first thing she said to me was, ‘So you want to switch [your driver’s license] from female to male?’”

Having to educate their doctor about trans identities and what it means to be non-binary was an extra burden for Pyrke, who had already gone through this process with their loved ones.

“I [have] to explain my gender to my doctor now too, on top of having to explain it to my family and my friends, and my colleagues, and my classmates.”

While Pyrke’s doctor later apologized for her lack of awareness and said she would learn more about trans-inclusive health care to better understand Pyrke’s situation, Pyrke said it shouldn’t have fallen on them to jump-start this change.

“The next day, she actually called me to apologize for what had happened and told me that [she was] going to try and do better moving forward,” they said. “[But] it shouldn’t take your first non-binary [or] trans patient for you to do that.”

Even when accessing reproductive services like a cervical screening, Pyrke has felt erased by the New Brunswick medical system. Their local clinic in Saint John is called the Women’s Wellness Centre, located in St. Joseph’s Hospital.

“I don’t want to go there because I’m not a woman,” they said. “It [doesn’t feel] right to me to have to conform […] because Saint John is not ready to accept me as who I am.”

Pyrke believes that in order to improve trans health care in New Brunswick as a whole, activists need to look beyond Fredericton.

“There’s only one place in the entire province that [LGBTQ2S+]  people can go [to] for their health needs,” they said. “Advocating for [the government] to keep Clinic 554 open isn’t going to fix the real systemic issues that are going on in New Brunswick.”

“We should be advocating for Clinic 554 to stay open, but we should also be holding our doctors accountable.”

In New Brunswick, while services like hormone therapy and gender affirmation surgeries are covered by provincial health insurance, there isn’t a provincial health framework for trans-inclusive care.

Comparably, in Ontario, there are organizations like Rainbow Health Ontario (RHO), and in B.C. there is a provincial information service and resource hub called Trans Care BC, intended to “make sure people have the information they need to access gender affirming health care and supports.”

According to Otteson, a lack of centralized trans health resources for New Brunswick residents makes it difficult for people in the province to explore transitioning.

“There’s not really a central organizing body or clinic that offers transgender-related care to people across the province […] where it’s their mandate to provide guidance or care to [LGBTQ2S+] New Brunswickers,” Otteson said.

“The way that trans folks access care in New Brunswick is through word of mouth,” she said. “When you’re coming from outside of the province, or if you don’t have a lot of social connections […] it is really hard to navigate the system here.”

While the provincial government in New Brunswick could make it a priority to provide an accessible framework for informing trans residents about their options, Otteson doesn’t see much progress in the current leadership’s future.

“I don’t think that the government really has a mandate or a desire to [improve trans health care]. Trans health is not a priority for them.”

When asked why she thought New Brunswick had made little progress towards creating a more trans-inclusive health system, Wyllie expressed a similar belief that the government didn’t consider the health of LGBTQ2S+ New Brunswickers a priority.

“People [ask why] people leave New Brunswick,” she said. “[The government] actively pushes away young people. It pushes away women. It pushes away [LGBTQ2S+] people. And that just reinforces New Brunswick being stagnant.”

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