Year in review

• Trans Care BC continued to improve the quality of the patient journey by improving the ways we teach and train, encouraging providers to ensure that care is holistic and individualised according to the patient’s goals with regards to transition-related medical care. 
• On February 15, 2023, Trans Care BC aligned gender-affirming surgical care processes with the new WPATH World Professional Association for Transgender Health (WPATH) is a professional organization devoted to transgender health, whose mission as an international multidisciplinary professional association is to promote evidence-based care, education, research, advocacy, public policy and respect in transgender health. Standard of Care (SOC) V.8 (2022) which reduced barriers for patients seeking gender-affirming surgery. In accordance with the new SOC, the following key changes in gender-affirming care Processes through which a health care system cares for and supports an individual while recognizing and acknowledging their gender and expression. in B.C. were implemented:
  • Only one surgical assessment, instead of two, is now advised for all gender-affirming genital reconstruction surgeries. This change will improve access and wait times for surgical readiness assessment An evaluation conducted by a health care professional to determine if a patient is ready to begin hormone therapy or have gender-affirming surgery. .
  • A former 'congruent living' requirement (where a person spends a duration of time living in the 'congruent' gender role) was removed.
  • The length of recommended hormone therapy prior to genital surgeries for adults, if indicated, was reduced from one year to six months.
• The health navigation team had over 6,000 interactions with community members, family members, loved ones and care providers to help people find care as close to home as possible. This is an 18% increase from 5,184 interactions in 2021-2022. 
   
• Trans Care BC provided 35 community grants to peer supported mental health & well-being projects in 2022-2023. The team hosted Provincial Network Calls and an in-person gathering (partially funded by Health Canada) of the funded projects in March 2023 to provide feedback to Trans Care BC, connect and share support, resources, and knowledge.
• Trans Care BC completed a review and update of the online Peer Support Directory, resulting in a refreshed directory that hosts 110 listings for peer support initiatives across BC. 

• As of April 2023, more than 31,150 registrants had completed the Introduction to Gender Diversity course on the LearningHub. Since its 2019 launch, non-profit organizations, public agencies and companies across Canada have made the course a part of their training. Adoptees of the E-Learning module include the Nova Scotia and Newfoundland health authorities, LifeLabs and more.
• On March 31, 2022, a new Indigenous Gender Diversity course was launched. This foundational course, developed in collaboration with gender diverse Refers to gender roles and/or gender expression that do not match social and cultural expectations. , trans Indigenous and Two-Spirit A term used within some Indigenous communities to reflect complex Indigenous understandings of gender and sexuality and the long history of sexual and gender diversity in Indigenous cultures. Two-Spirit encompasses sexual, gender, cultural and spiritual identity. It may refer to cross-gender, multi-gender or non-binary gender roles, non-heterosexual identities, and a range of cultural identities, roles and practices embodied by Two-Spirit peoples. Some people also use "2-Spirit" or "2S." (Source: Battered Women’s Support Services) community members, is for people working in health and other care and support settings to increase their awareness, knowledge, and skills when working with gender diverse, trans Indigenous and Two-Spirit people across British Columbia.
  • Thanks to feedback from the community during its pilot phase, the publicly accessible version of the course launched in spring 2022. 
  • Further community feedback encouraged an expanded version of the module that launched in January 2023. 
  • The updated module features more media elements than in its earlier form, to bring additional perception to written content. More than 1,700 registrants have signed up to complete the course, to-date.   
• From April 2022 to March 31, 2023, we continued to offer the weekly Clinical Mentorship Call with a number of new mentors added to the rotation. There were 14 unique mentor disciplines represented, including family physicians, psychologists, pharmacists, social workers and more.
  • Between October 2022 and March 2023, there were 486 participants all across the province joining as mental health clinicians, support workers, family physicians, nurse practitioners, and more.
• We launched a Supporting Gender Creative Children and their Families online module designed for people who work with children and their families in various capacities. This includes, but is not limited to, day care, school, community centres, social work, health care, and mental health care. Over 945 registrants have signed up, to-date.
• In 2022-2023, 58 clients completed Changing Keys, Trans Care BC’s intensive speech and voice training program, through virtual one-on-one sessions and virtual group sessions. This voice feminization program, is the only publicly-funded program of its kind in B.C. that supports trans people with changing their speech.  The Trans Care BC program began to work on exploring options to try to expand voice services in order to improve access for those with alternative voice goals and to reduce wait times for this resource.
• For International Non-Binary People’s Day on July 14, an article outlining how health-care providers can do their best to provide care, and including essential terminology and available resources appeared on phsa.ca. The article was also shared with the PHSA staff community.

While working with community members to navigate care, Trans Care BC also collaborated to grow health system capacity. 

• The Gender Surgery Program BC (GSPBC) launched in 2019, and has scaled up to offer the full spectrum of genital reconstruction surgeries including vaginoplasty A gender-affirming genital surgery to create a vulva (including mons, labia, clitoris and urethral opening) and vagina. , vulvoplasty A gender-affirming genital surgery to create a vulva (including mons, labia, clitoris and urethral opening) and remove the penis, scrotum and testes. Vulvoplasty creates the external aspects of a vulva without creation of a vaginal canal. , phalloplasty A gender-affirming lower surgery to create a penis and scrotal sac (phase 1) followed by testicular implants and implants to obtain rigidity/erection (phases 2 and 3). , and metoidioplasty A gender-affirming lower surgery to create a penis. Metoidioplasty involves cutting ligaments around the clitoris to add length to the shaft and grafting skin around the shaft to create more girth. Optional additional procedures include scrotoplasty and urethral lengthening. procedures. We are working with health system partners to continue to expand provincial access to lower gender-affirming surgeries. 
• We continue work to improve access to medically necessary pre-surgical hair removal, which is funded following a recommendation from the surgeon, as required, in preparation for genital reconstruction surgeries. 
• Gender-affirming chest and breast surgeries were stable from last year: 660 breast and chest surgeries were performed in 2022/23, with over 90% of surgeries completed within 26 weeks of booking form submission (the benchmark wait time).
• Weaving patient feedback into the tools we create, we continued to provide tools to help clients plan for surgery, post-operative care, and recovery, with patient’s safety and wellbeing in mind. 

• In April 2022, Trans Care BC was awarded $3.2M from the Sexual and Reproductive Health Fund (federal government) to develop an enhanced suite of educational tools and resources for care providers, patients and their supporters.
• These new tools and resources will address specialized topics in the areas of sexual health screening Process of checking for signs of a health issue or medical condition before symptoms appear. & treatment, fertility & perinatal care, and perioperative care for lower gender-affirming surgeries.
  • This funding was enhanced, through an amendment, with an additional contribution of $1.8M in March 2023 to add additional content and communication resources to amplify aspects of the project that will be highest impact.
  • A new Learning Management System, a live, evidence-based, clinical educational program (ECHO), and a new website will be developed alongside the new asynchronous E-learning modules and tools.

• Trans Care BC collaborated with the PROGRESS (Patient-Reported Outcomes of Genital Reconstruction and Experiences of Surgical Satisfaction) for phalloplasty A gender-affirming lower surgery to create a penis and scrotal sac (phase 1) followed by testicular implants and implants to obtain rigidity/erection (phases 2 and 3). and metoidioplasty A gender-affirming lower surgery to create a penis. Metoidioplasty involves cutting ligaments around the clitoris to add length to the shaft and grafting skin around the shaft to create more girth. Optional additional procedures include scrotoplasty and urethral lengthening. study. PROGRESS is an international, cross-sectional study of outcomes of phalloplasty and metoidioplasty for trans and non-binary Umbrella term referring to people whose gender does not fall within the binary gender system of woman/girl or man/boy. Some individuals identify as non-binary while others may use terms such as gender non-conforming, genderqueer, or agender. Non-binary people may or may not conform to societal expectations for their gender expression and gender role, and they may or may not seek gender-affirming medical or surgical care. people that is comprehensive and driven by lived experience. This study began reporting outcomes in 2022 and will be releasing data and knowledge translation projects to inform researchers, community members and providers.
• Since 2022, PRIDE-RX (Promoting 2SLGBTQQIA+ Inclusion, Diversity, and Equity in Pharmacy Education) is a University of British Columbia project that aims to integrate sexual orientation Refers to terms such as lesbian, gay, straight, and queer, which are based on patterns of emotional, romantic, and/or sexual attraction to groups of people. Sexual orientation terms are commonly (but not always) defined by the gender(s) of the people that the individual is attracted to. Sexual orientation also refers to a person’s sense of identity based on those attractions, related behaviors, and membership in a community of others who share those attractions; for example pansexual, bisexual, LGB, heterosexual. and gender identity A person's deeply held, internal sense of themself as male, female, a blend of both or neither. (Source: GenderSpectrum.org) and expression into the curriculum throughout four professional years in the Entry-to-Practice Doctor of Pharmacy program.