Transgender/Gender-Affirming Health

What are the steps in the transition process in Nova Scotia?

Pride Health has produced a great set of guidelines that outlines all of the steps of the hormonal transition process, surgical options, and legal transition in Nova Scotia, as of 2020.

HSHC can help with any aspect of a person’s transition, including the MSI approval process and surgical arrangements.

If you’re not sure where to start, we can help!

What kind of transgender support does HSHC offer?

The HSHC can help with essentially all aspects of the transition process, such as:

Gender affirming hormones
Help with MSI referral for surgery approval
Help with arranging surgery with Montreal (once it is MSI approved)
NEW (2023) – Social work support (Surgical Readiness letters, identity support, resource navigation, etc)
Post operative care
Emotional support
General sexual and reproductive health care

How do I book and prepare for an appointment at HSHC?

Booking an appointment with us is easy! Give us a call at 902.455.9656 ext. 0. You will need to speak to one of our medical administrators. They are always in the office Monday-Friday from 9:00 am – 4:00 pm (with the exception of holidays), but are not always in the office during our evening clinics (4:30 pm – 8:00 pm), so it is best to call during the day. We cannot book appointments over email or Facebook. You cannot book an appointment for someone else, even if they are your partner or child. We will need to speak with them directly. To book, we will need your full name as it appears on your health card, birth date, and phone number. You are also safe to share your pronouns and lived name with our admin while booking. We will always refer to you as you prefer!

If you are coming to start the process for gender affirming hormones and/or medical transition, you may be a placed on a waitlist. Since May 2024, we have been able to maintain access to gender-affirming hormones without a waitlist. It is possible that the waitlist will return if demand exceeds our capacity.

If you are moving to Nova Scotia from another province and are already on hormones, you can transfer your care to HSHC. Please note that there may be a wait to access our services. You should call us as soon as possible to prevent an interruption in your care. You should also contact your original provider before leaving your province to maintain your prescription while you wait. We will need any relevant medical records from your previous provider, such as readiness letters, mental health assessments, recent bloodwork, prescription history, etc. You should arrange to access those records before booking with HSHC.

NEW (2023) – You no longer require a Letter of Readiness before being placed on our wait list to start hormones. HSHC is shifting to an informed consent model where most patients will no longer require any formal mental health assessment to access hormones. If you already have a Letter of Readiness, you can still place yourself on our waitlist, but it will not gain you access to care any faster.

The administrator will let you know when to expect the call to book your first appointment. The admin will typically book your appointments all at once. Make sure you bring your valid provincial health card with you to your appointment. Clients without health cards are subject to doctors and lab fees.

Do you have questions about the transition process? We can help! You are welcome to book an appointment with one of our doctors or nurses without being on the waitlist.

Other than that, just bring (and be) yourself! We look forward to meeting you.

Are you a youth? You do not need parental consent for any of our appointments. However, you must be 18 for us to provide gender-affirming hormone prescriptions. If you are under 18, you can access gender-affirming care through the IWK Trans Health Care Team. You can self refer to them by calling 902-464-4110 or toll free 1-855-922-1122.

Don’t have access to or lost your health card? You are entitled to your health card information! Call MSI toll-free at 1-800-563-8880 (in Nova Scotia) or at 902-496-7008 from Monday-Friday 8am-5pm. We require the number and the expiry date. Another tip: take a picture of your card! You will never lose it again!

What can I expect during my appointment at HSHC?

If you are coming in for gender affirming hormones, this will involve three visits. This would include an intake with our social worker, and two doctors appointments (with the same doctor). These visits are longer than a traditional doctors appointments, approx. 30-45 minutes. These visits will range from 2-4 weeks apart, depending on the clinic schedule and your availability. All of these visits are free with a valid health card.

Some components of appointments may be available as a virtual or telephone visit format. Please let us know if you are interested in this option!

Pre-Visit: The admin team will mail you information, consent forms, a health history form, and a bloodwork requisition form.
Intake Visit: You will meet with a social worker to discuss transition goals, review health history, etc. The social worker will not be writing a formal letter or providing any diagnosis, but will be collecting information so that the doctor can be more efficient during their appointment with you.
Visit #1: Meet and greet, review intake information, and a non-invasive physical exam. You will not need to do anything you are not comfortable with. The purpose of this exam is to ensure you are healthy and well.
Visit #2: A review of your bloodwork results, you will sign consent forms to start your hormone therapy and get your prescriptions that day. You can also discuss surgery options, if you are interested.
If you are starting on testosterone, you can book a follow up appointment with one of our nurses who will help teach you how to do your injection. You are welcome to bring a support person with you. We sell injection supplies on site for $52.50 for a weekly supply/year and $28.75 for a bi-weekly supply/year. Please note that we cannot sell injection supplies after 4:30 PM. As of January 2025, we are able to offer injection supplies for FREE for at least one year, thanks to the CFNS VISIONS fund!
If you ever need help doing your own injection at home, check out the videos below of our nurse going through the steps of both IM and SubQ injections!
- This instructional video is not meant as a substitute for professional medical advice. It is an extra resource for those already receiving hormone therapy care. Individuals are recommended to consult with a qualified medical professional before self administering any new medications.

What are the wait times for referrals, surgery, etc.?

Referrals for surgical WPATH readiness letters will depend on if you will be going to the HSHC social worker, a private psychologist, or through MSI.
- If you are going through the HSHC social worker, you will likely be seen within a few weeks-months. This service is free thanks to funding from Sexual Health Nova Scotia.
- If you are going through a private psychologist (if you have coverage or are paying out of pocket), you will likely get seen within a few months.
- If you will be going through MSI (covered by provincial health care), wait times range from 6-18 months.
- If you are looking for a readiness letter writer, you can find a directory of mental health professionals here: Queer and Trans Therapists NS Directory
MSI approval for surgery: Once we have your letter(s) of surgical readiness, you can come to HSHC to fill out MSI approval documents. We will then forward this to MSI. It takes approximately 4-6 weeks to receive notification of approval from MSI. Once we have approval, we will contact you for a follow up appointment. We would either then begin planning for you to go to Montreal, or if you are getting surgery in Nova Scotia, the local surgery team should contact you regarding booking a pre-operative appointment(s).
Referral to Montreal for surgery: Many gender-affirming surgeries are only available in Montreal. If you require a referral for surgery, HSHC can help with this. We fax off all required documents to Montreal. They will contact you from there. If you DO NOT receive a package from Montreal within one month, its very important that you call them. We can give you their phone number. Wait times for surgery are very variable, but often range from 6-18 months.

How do I change my name/gender marker?

Details on how to legally change your name are outlined on the Nova Scotia government website.

Gender marker changes: You will need to fill out a form for Vital Statistics which we can provide or you can access online. This form needs to be signed by one of our doctors. You will then bring this form to one of the Vital Statistics office locations, and they will begin processing your request.

Where can I go for support in the community?

HSHC would like to thank the Mental Health Foundation of Nova Scotia for funding our integrated social worker pilot project (Fall 2022-23). This funding was pivotal for our transition to an informed consent model. We would also like to thank Sexual Health Nova Scotia for funding our social work support program for the 2023-24 fiscal year.

We are proudly supported by the Mental Health Foundation of Nova Scotia for the 2024-25 fiscal year. This support has allowed us to expand our social work scope from beyond gender-affirming care and into primary care support. Thank you!