Clinic 554 turns down 30 transgender patients because of uncertain future

Karen Woolley was ready to start hormone therapy to physically transition to a woman. She walked into Clinic 554 in Fredericton to see if it received her doctor's referral, but the person at the desk said the clinic had stopped taking patients indefinitely.

"OK, so physically transitioning — that journey has ended," she thought to herself.

The 45-year-old retired military reservist is one of 30 people who've been turned away at the clinic since December.

For her, it wasn't the end of the road. She got an appointment with an endocrinologist in Moncton a few weeks later, although she counts herself one of the lucky ones.

"You don't have a lot of safety in this whole process, I don't feel there's a lot of support."

A gap in services is getting wider since Clinic 554 in Fredericton was put up for sale. The short list of doctors who are comfortable prescribing hormone therapy for transgender patients in New Brunswick got even shorter when Dr. Adrian Edgar stopped taking on new transgender patients.

Edgar has focused on transgender care and abortion services, although his family practice serves a range of patients.

Clinic 554 is the only private clinic that provides out-of-hospital abortions. Edgar announced last year that he was putting it up for sale because the lack of provincial funding for these abortions makes running the clinic unsustainable.

He doesn't have a buyer yet, but because he could close any day, Edgar said, he can't begin a years-long relationship with people requiring consistent hormone treatment, the first step to physical gender transition.

Most people transitioning from one gender to another begin by socially transitioning, or dressing as the gender they identify most with. Hormone replacement therapy is the next step and paves the way to a full physical transition that includes gender-affirming surgery and chest masculinization and feminization.

"Not being able to predict that we would be open for 12 months, it doesn't seem safe to me to sort of start a process with someone that I wouldn't be able to finish," Edgar said.

He's also started referring his more than 300 established transgender patients back to their primary care providers. People who don't have a family doctor or nurse practitioner, he's keeping on until the clinic closes.

The province has previously said it has no plans to fund out-of-hospital abortions because the procedure is available in two hospitals in Moncton and one in Bathurst — and that constitutes enough access.

Three doctors

Joselyn O'Connor with the transgender advocacy group UBU Atlantic said her organization has been approached by about 20 people looking for help in the last two weeks and expects the number will keep going up.

"I do know that we have a lot of people here that do go to Fredericton for their health care," she said in an interview from Moncton.

UBU Atlantic provides peer support for trans and questioning people, and helps them navigate and find resources and health care. She said the only thing her organization can do now is provide patients with the names of New Brunswick's three endocrinologists to contact or try to get referred to.

"It's a very short list," said O'Connor. "Two of them are in Moncton one is in Saint John."

The waiting list once a person gets hold of these doctors could be as short as two weeks or as long as nine months, she said.

Closure timeline

Edgar said he's given two tours to people interested in buying the clinic, and he'll be selling as soon as he gets an offer. He's not holding out for someone who will continue running a clinic out of the building, he said.

"If there's an offer I'm not in a position to hold off," he said. "I haven't been able to recruit anyone to buy the practice."

Edgar said he can't just stop offering abortions or continue to practise outside Clinic 554 because he doesn't want to continue operating in a province where the government is not willing to talk with him or improve abortion access and transgender health care.

"If the clinic is sold, I would find it difficult to continue working in a province where I feel so disrespected," he said.

He said he's considered returning to the Canadian Armed Forces, where he was a physician for some years before he moved to Fredericton.

He said not all the people who've been turned away by the clinic are from Fredericton. Some come from other parts of the province and from Prince Edward Island. He said his clinic is the only one where transgender patients can "self-refer" and don't need a referral from a psychiatrist, so it's not easy to turn them down.

"[This is] the kind of job that's difficult at the best of times, and then when you feel like you're a part of that suffering, when you're exacerbating that suffering, it's enough to make anyone want to quit."

Who can lighten the load

Primary health care providers can and are allowed to administer hormone therapy for transgender patients, and they don't have to be hormone specialists, said Dr. Ed Schollenberg of the College of Physicians and Surgeons. However, many are not comfortable doing it or feel they don't have the training.

"There's nothing that says they can't prescribe A, B or C. It's just a question of how you do it, what is it, when do we start this or how long does this go on for," Schollenberg said. "They may simply just not have had the experience and certainly would not have had the training to provide that service."

O'Connor said most of the family doctors in the province don't know how to treat or take care of trans patients, but she said the community is counting on them to lighten the load on the specialists.

They can do that by working with the specialists to understand how to properly administer hormone therapy, she said.

"They can learn and maybe be better equipped in the future. But until we have another resource that's as good as Clinic 554, I think we're going to be struggling for a bit."

Training for primary care providers?

Schollenberg said it's up to individual physicians to seek this training and decide when they feel they're equipped to decide what dosage of hormones are appropriate for their patients.

"I think the incentive is your willingness to assist patients and your acceptance that this is the answer for them," he said,

He said it's not immediately clear where they can get the training, but Edgar said he's previously recorded an online training course about this issue. The New Brunswick Medical Society has also funded training trips to different parts of the province, he said.

"Training, people are hungry for it," he said. "People are stepping outside of their comfort zones, but we really need to look for the government to fund access to appropriate supports."

Some other provinces, including Nova Scotia, have a province-funded program that provides training for doctors who want to learn.

554 not the end of the road

Woolley said her experience can show that losing Clinic 554 might not be the end of the road for people needing hormone replacement therapy, but she also realizes she has privileges — such as financial stability and a car — that allow her to go to an appointment in Moncton.

"Other people, they can't even afford $115 to change their name," she said.

So even though "it's hard and it feels like I'm hitting walls," she said she's trying to focus on the positive experiences.

"I'm scared a lot but I'm also grateful for the doors that have been opened for me."