Medical Transition Education for Healthcare Providers

Prescribing and managing gender-affirming hormones like estrogen or testosterone. A discussion of risks, expected physical changes, and non-reversible changes with hormone therapy is important. Referral for fertility preservation should be discussed and offered prior to the start of hormone therapy.

Consent Form for Estrogen and/or Testosterone Blocking Therapy

Trans primary care: Guide to caring for trans and gender-diverse clients.

Heartland fertility: Supports trans individuals on their fertility journey.

Consent Form for Testosterone Therapy

Consent Form for Progestin Therapy

Routine screenings tailored to individual needs, including cancer screenings and sexual health services.

Any MD or NP in Manitoba can send referrals directly to surgeons for the following publicly-funded gender-affirming procedures:

• Top surgery (chest masculinization or breast augmentation)
• Hysterectomy with or without oophorectomy
• Orchiectomy
• Dermatology for laser hair removal
• SLP voice therapy at Deer Lodge

Review the Standards of Care Version 8 guidelines of the World Professional Association of Transgender Health (WPATH) to self-assess your competency and knowledge to initiate gender-affirming medical and surgical treatments.

The referral letter will require the diagnosis of gender dysphoria/gender incongruence, and how the individual meets the WPATH (Chapter 5) criteria for initiation of gender-affirming medical and surgical treatments.

Primary care providers can refer clients to THK, or folks can self-refer. There is an 8 to 12 month wait, so we encourage providers to incorporate gender-affirming care as part of their practice.

Referrals for genital reconstructive surgery must come from an “approved adult health professional”. These referrals will require a letter of referral/recommendation without the need for an assessment by an approved mental health specialist unless there are underlying mental health complexities /concerns.

To become an “approved adult health professional” in Manitoba for gender affirming referrals, submit a copy of your CV and cover letter to at the following address:

Klinic Community Health
Attn: THK Nurse Coordinator
167 Sherbrook St
Winnipeg, MB R3C 2B7

Please outline how you meet criteria for being an approved adult health professional, which are consistent with recommendations from WPATH.

The following are the minimum credentials for health professionals who work with adults 16 years and older who present with gender dysphoria or gender incongruence to be eligible:

1. Must be registered with the College of Physicians and Surgeons of Manitoba and hold a full license to practice medicine in Manitoba; or Nurse Practitioner registered with the College of Registered Nurses and hold a license in Manitoba (CRNM). Additional Health Professionals (i.e. Physician Assistants) may be considered in the future as their role and status evolves).
2. Competency in using the Diagnostic Statistical Manual of Mental Disorders and the International Classification of Diseases for diagnostic purposes, and the current WPATH Standards of Care for assessment and treatment purposes.
3. Knowledgeable about gender diverse identities and expressions, and the clinical aspects of gender dysphoria, gender incongruence and diversity, including gender affirming treatments.
4. Undergo continuing education in healthcare relating to gender dysphoria, gender incongruence and diversity. This may include attending relevant professional meetings, workshops, or seminars; obtaining supervision from a health professional with relevant experience; or participating in research related to gender diversity.
5. Ability to recognize and diagnose co-existing mental health concerns and distinguish these from gender dysphoria, gender incongruence and diversity.
6. Ability to assess capacity to consent for treatment.

We are happy to help facilitate this through educational opportunities and/or consultation with our team. Please contact the nurse coordinator with general questions or to request examples of assessments and referrals at 204-784-4003, or fax/econsult at 204-784-4013 for specific client questions.