How to Access Hormone Therapy for Youth in British Columbia: A Guide for Parents

Introduction

For many transgender and gender-diverse youth, gender-affirming care—like hormone therapy and puberty blockers—can offer immense relief, fostering a sense of alignment between their bodies and identities. These treatments can reduce the mental and emotional distress associated with unwanted physical changes, particularly during the sensitive and transformative years of adolescence. Yet, accessing hormone therapy and puberty blockers in British Columbia (BC) can be daunting for families. Many parents find themselves navigating a complex and unfamiliar healthcare system, unsure of where to turn or how best to support their teens on this journey.

This guide is designed to simplify the process, offering a clear path forward by outlining key resources and pathways to care in BC. It highlights the essential role of primary care providers, whether they serve as the first point of contact or refer families to specialized services. Additionally, it details the supportive standards set by the World Professional Association for Transgender Health (WPATH), which advocate for best practices in youth care and provide a framework for healthcare providers to ensure that all youth receive informed, affirming, and compassionate support (World Professional Association for Transgender Health, 2022).

Each step described here not only aims to ease families’ navigation through the healthcare system but also prioritizes their agency in accessing timely and appropriate care. By understanding the options available—from working directly with primary care providers to accessing specialized clinics—parents and youth can make informed decisions that best align with their unique needs and values.

Initiating Gender-Affirming Care: Connecting with a Primary Care Provider

For families beginning the journey of accessing hormone therapy for youth, connecting with a primary care provider (PCP) is often the essential first step. A PCP—whether a family doctor, nurse practitioner, or registered nurse—serves as a starting point in assessing a young person’s readiness for hormone therapy. With training in gender-affirming care, many PCPs in BC are equipped to provide initial guidance, conduct readiness assessments, and in some cases, even prescribe hormone therapy directly. This early support can foster a compassionate and reassuring experience for both youth and parents as they begin navigating the path to affirming care.

However, not all PCPs feel equipped to provide gender-affirming care, especially with younger patients. If a PCP is not experienced or comfortable handling this aspect of care, they can refer families to alternative providers with specialized expertise. This referral process can include several supportive pathways:

•Direct Care and Prescribing: For PCPs with the necessary knowledge, providing both the readiness assessment and hormone prescription can streamline the process. This option reduces wait times and allows youth to receive care from a familiar and trusted provider, fostering continuity.

•Consultation and Guidance: PCPs who may be less familiar with gender-affirming care can seek guidance through resources like Trans Care BC’s Primary Care Toolkit, which provides accessible information for providers on best practices in transgender healthcare (Trans Care BC, n.d.-b). Additionally, PCPs have access to the RACE line, a resource that connects them with experienced clinicians for timely consultation, ensuring that youth receive competent, knowledgeable care.

•Specialized Referrals: In cases where a PCP feels additional expertise is necessary, they can refer the youth to an endocrinologist or a mental health professional specializing in gender-affirming care. Endocrinologists provide detailed hormonal support and ongoing care, while mental health professionals may assist in readiness assessments for hormone therapy, addressing any mental health concerns that could impact the process.

For families without a regular PCP, options such as walk-in clinics and virtual medical consultations can be valuable alternatives. These services may guide families to the next steps, including referrals to experienced providers, thereby ensuring that youth can access care without facing prolonged uncertainty or delay.

Pathways to Access Hormone Therapy for Youth in BC

British Columbia offers three primary pathways for youth to access hormone therapy and puberty blockers, although availability and wait times may differ based on the provider and location.

Pathway 1: Primary Care Provider (PCP) Support

Youth and their families can start by consulting a primary care provider (PCP) such as a family doctor, nurse practitioner, or registered nurse. In some cases, the PCP is able to conduct a readiness assessment and prescribe hormone therapy directly if they feel equipped to provide gender-affirming care. For PCPs who may be unfamiliar with these assessments, Trans Care BC offers resources like the Primary Care Toolkit and the RACE line to connect them with experienced clinicians (Trans Care BC, n.d.-b). If further support is required, the PCP can refer the youth to a mental health professional or endocrinologist for assessment and treatment. This pathway provides a personalized approach and allows families to begin care locally with fewer initial steps.

Pathway 2: Referral to an Endocrinologist

In cases where a primary care provider (PCP) may not feel equipped to conduct the hormone readiness assessment or manage hormone therapy, they can refer the youth to an endocrinologist. This pathway often requires a readiness assessment from a qualified mental health professional, such as a psychologist, social worker, or psychotherapist, before hormone therapy can begin. As practices and policies vary by provider, it’s essential to confirm with the endocrinologist which types of assessment letters they accept.

Audrey Wolfe, RCC offers hormone therapy assessments for youth for specific endocrinologists, providing another support option for families pursuing this pathway.

Pathway 3: Accessing Care Through Trans-Specific Clinics

Trans-specific clinics and dedicated gender-affirming providers offer a supportive pathway for youth seeking hormone therapy and puberty blockers. These clinics, such as BC Children’s Hospital or a few Foundry BC locations with gender affirming care services, typically integrate readiness assessments with follow-up care, streamlining the process for families. However, accessibility varies by region in BC, so families are encouraged to connect with Trans Care BC’s health navigation team to find options within their area. You can reach a Health navigator from the Trans Care BC site.

For youth under 17, BC Children’s Hospital’s Gender Clinic provides specialized care, though access requires a referral from your PCP or a walk-in clinic. This clinic supports youth at various stages, offering early consultations that focus on social transition resources, information-sharing, and long-term planning options. For younger children, especially those under 7, the clinic is flexible and can meet with parents alone if preferred. This early engagement can be helpful for families, as it allows them to receive support and digest information at their own pace without immediate pressure to begin medical interventions. The intake process is generally brief, allowing families to connect with resources within a few weeks, though other care stages may involve monthlong wait times. For specific questions about the services at BC Children’s Hospital, the Gender Clinic team is also available to provide assistance and answer questions. Contact them at genderclinicians@cw.bc.ca.

Exploring the Role of Puberty Blockers in Youth Gender-Affirming Care

For transgender and gender-diverse youth, puberty blockers are often a key early step in their gender-affirming journey, providing both emotional relief and a sense of bodily alignment. By temporarily pausing the irreversible physical changes of puberty, these medications offer young people the opportunity to explore their gender identity in a supported and affirming environment.

One significant advantage of puberty blockers is that they allow youth the time and space needed to make thoughtful decisions about further gender-affirming care. By holding off puberty-related changes such as the development of secondary sex characteristics, blockers help youth avoid some of the physical adjustments that may later require surgical intervention or extensive treatment to reverse (Trans Care BC, n.d.-a). This relief can be particularly valuable in reducing gender dysphoria and its associated stressors, providing youth and families with peace of mind during a typically challenging developmental period.

The most commonly prescribed puberty blocker in BC, Lupron Depot, is administered through injections and is covered by BC PharmaCare, making it accessible to many families. Given the time-sensitive nature of starting puberty blockers, prompt access to these medications is essential. The readiness assessment process considers a range of factors, including the youth’s understanding of puberty blockers, the presence of a supportive environment, and their overall physical and mental health, ensuring a comprehensive and compassionate approach to care (Trans Care BC, n.d.-a). This assessment process supports youth in accessing the care they need while providing guidance to families and caregivers about the best path forward.

Ultimately, puberty blockers play a vital role in aligning a young person’s physical experiences with their gender identity, offering a stable foundation for the youth to make informed decisions about their future. As an option that promotes both physical and mental well-being, puberty blockers underscore the importance of timely, accessible, and affirming gender care for youth in BC.

Hormone Therapy Eligibility and Readiness: Navigating the Requirements for Youth

Hormone therapy can be a life-changing intervention for transgender and gender-diverse youth, yet it requires careful assessment to ensure safety and support. The WPATH Standards of Care Version 8 (SOC8) outline eligibility criteria to provide clear, affirming, and medically sound guidelines for youth accessing hormone therapy.

To be eligible for hormone therapy, youth must demonstrate consistent and well-documented experiences of gender incongruence. This alignment with diagnostic criteria helps clinicians assess the youth’s personal journey, confirming that hormone therapy aligns with their long-term goals (World Professional Association for Transgender Health, 2022). Additionally, the SOC8 emphasizes the importance of emotional and cognitive maturity, as youth need to understand both the short- and long-term effects of hormone therapy, allowing them to provide informed consent—a crucial aspect of the readiness process.

Stable psychosocial readiness is also central to eligibility, and clinicians work to ensure that any existing mental health conditions are well-managed. This stability helps create a supportive environment for hormone therapy, allowing for better mental health outcomes and adjustment as youth experience physical changes in alignment with their gender (World Professional Association for Transgender Health, 2022). Finally, the SOC8 recommends that youth reach at least Tanner Stage 2—a developmental milestone indicating the early stages of puberty—before starting puberty blockers, which ensures that the treatment effectively pauses further pubertal development.

The readiness assessment goes beyond eligibility by creating a supportive space to explore the youth’s goals, support systems, and expectations for hormone therapy. Providers may discuss how hormone therapy will influence the youth’s physical development, ensuring families and caregivers are also prepared to offer support throughout the process. Additionally, physical exams and blood work may be incorporated into this assessment, offering a thorough health check to confirm the youth’s readiness and safety for starting hormone therapy (Trans Care BC, n.d.-a; World Professional Association for Transgender Health, 2022). This assessment not only prepares youth for the physical changes ahead but also serves as a foundation for ongoing, affirming care that respects their unique journey.

In sum, the eligibility and readiness assessments provide a structured yet compassionate approach to hormone therapy, supporting youth as they navigate gender-affirming care in BC.

Essential Supports and Considerations for Families Navigating Hormone Therapy

Supporting youth through gender-affirming care requires navigating various considerations beyond the initial assessment and eligibility requirements. Financial support, emotional resources, mental health support, and ongoing medical monitoring all play essential roles in making this journey manageable and affirming for both youth and their families.

Financial Support

Navigating the costs associated with hormone therapy can be challenging, but there are options available to help manage these expenses. In British Columbia, PharmaCare covers several medications for hormone therapy, including Lupron Depot, a commonly prescribed puberty blocker (Trans Care BC, n.d.-a). Some extended health insurance plans may provide partial or full coverage for these medications. Additionally, Indigenous youth and families may be eligible for financial assistance through the First Nations Health Authority (FNHA), which can help alleviate the financial burden of ongoing treatment. Families are encouraged to discuss these options with their healthcare provider, who can offer further guidance on maximizing available support.

Emotional and Peer Support

The journey of hormone therapy can bring about a range of emotions for both youth and their families. Emotional and peer support resources, such as counseling and family support groups, provide vital spaces to process these changes. For many, connecting with others who share similar experiences offers comfort, insights, and a sense of solidarity, easing the social and emotional aspects of gender-affirming care (Trans Care BC, n.d.-b). Parents and caregivers are encouraged to seek out these supportive communities to enhance their understanding and to foster resilience as their child’s journey unfolds.

Mental Health Support

Accessing gender-affirming care can be complex, and youth may encounter obstacles while navigating this path. Mental health support from a registered clinical counsellor (RCC) can be instrumental during this time, especially when youth face challenges, such as finding a primary care provider or obtaining referrals. Audrey Wolfe, RCC, is available to support youth with these logistical and emotional steps, such as problem-solving around walk-in clinic referrals or preparing youth for appointments. Research indicates that waiting for gender-affirming care can be a difficult period for many youth, making ongoing mental health support valuable for managing anxiety and other challenges that arise. For parents, having their own support network is equally important, and I am available to provide guidance and support as they navigate this journey alongside their child.

Ongoing Monitoring and Medical Support

Regular follow-up care is a crucial component of hormone therapy, particularly in the early stages. Youth should attend consistent check-ins with their healthcare provider to monitor their body’s response and ensure their health and safety. These follow-ups often involve blood work and evaluations to track hormone levels and adjust dosages as needed. By staying engaged with ongoing monitoring, families can be confident in their child’s well-being, knowing they are receiving affirming and individualized care (Trans Care BC, n.d.-a).

With these supports—financial, emotional, mental health, and medical—families are better prepared to guide their child through gender-affirming care, empowering them to navigate this meaningful journey with confidence, compassion, and resilience.

Conclusion: Championing Access to Gender-Affirming Care for Youth in BC

Securing hormone therapy and gender-affirming care for youth in British Columbia may seem daunting, but the province offers a variety of pathways to support this essential journey. From primary care providers to specialized clinics and resources like Trans Care BC, there are options tailored to meet each family’s unique needs. By working together with supportive professionals, connecting with informed networks, and utilizing available financial and emotional resources, families can help their youth access compassionate, affirming care that supports their gender identity.

For families seeking guidance, reaching out to Trans Care BC can be a valuable first step, as they provide information on regional resources, support groups, and care options that align with WPATH standards. Embracing this collaborative approach allows families to feel empowered, ensuring their youth receive the care they need to thrive on their path to self-discovery and wellbeing.

If you have questions or need guidance as you navigate gender-affirming care for your youth, consider reaching out to a Health Navigator at Trans Care BC. They can offer valuable information on available pathways, financial support options, and emotional resources to support you and your family along the way. You can contact a Health Navigator here.

For specific questions about the services at BC Children’s Hospital, the Gender Clinic team is also available to provide assistance and answer questions. Feel free to reach out to them at genderclinicians@cw.bc.ca.

Taking the first steps toward accessing hormone therapy may feel overwhelming, but compassionate resources and dedicated professionals are here to guide you through each stage, ensuring your youth receives the affirming care they deserve.

References

Trans Care BC. (n.d.-a). Puberty blockers. Retrieved from https://www.transcarebc.ca/hormone-therapy/puberty-blockers

Trans Care BC. (n.d.-b). How to start hormone therapy. Retrieved from https://www.transcarebc.ca/hormone-therapy/how-to-start

World Professional Association for Transgender Health. (2022). Standards of care for the health of transgender and gender diverse people, Version 8.