Trans Health Guide for Youth (Ontario)

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Table of Contents

• How to know if you’re transgender
  
• Definitions
  
• Signs you might be trans
  
• Social transitioning
  
• Coming out
  
• Changing name
  
• Pronouns
  
• Gender expression
  
• Medical transitioning
  
• HRT
  
• Surgeries
  
• Resources
  
• Support groups
  
• Helplines
  
• Books, websites, youtube channels, etc.
  

Trans 101

• biological sex - the sex someone is assigned at birth, usually based on anatomical features (often referred to as AFAB or AMAB)
• gender identity - a person's individual experience of gender
• gender expression - how someone chooses to present their gender
• sexual orientation - the direction of who someone is sexually interested in
• transgender - someone whose gender identity does not match the sex they were assigned at birth
• gender dysphoria - a sense of unease because of a mismatch between biological sex and gender identity
• AFAB - assigned female at birth
• AMAB - assigned male at birth
• FTM - a trans man who was assigned female at birth
• MTF - a trans woman who was assigned male at birth
  

• nonbinary - an umbrella term for someone who does not identify as strictly male or female (can be neither, both, or in between)
• intersex - someone born with characteristics that don't fit into the usual binary male and female standards
• genderfluid - someone who does not have a fixed gender
  
• demigender - someone who feels a partial connection to a gender identity (eg. demigirl, demiboy)
  
• agender - someone who does not have a connection with any gender
  
• genderqueer - someone who does not identify as strictly male or female (can be neither, both, or in between)
  
• 2-spirit - an umbrella term that some Indigenous North Americans use for another gender
• More terms and definitions can be found in the Rainbow Health Ontario (RHO) Glossary.
  

Signs you might be trans

You are questioning your gender. (Most cis people don't feel the need to question their gender because they are comfortable with their AGAB.)

You feel uncomfortable when referred to as the gender you were assigned at birth. (aka gender dysphoria)

Getting gendered correctly or differently than you are used to feels amazing! (aka gender euphoria)

Going through puberty was a very uncomfortable experience for you in a different way than for most people.

You have a feeling that you are different than other people.

It takes time to figure out who you are, so take as much time as you need to feel confident in your identity and try to figure out what makes you happy.

Helpful resources

• 5 Signs You Might Be Transgender - Lynn Saga
• Trans Guy: How to Know if You're Transgender - Jammidodger
• Am I transgender? How to figure out if you're transgender - Ashley Adamson
  

Social Transitioning

What is social transitioning?

• You can start to live as your authentic self even before you receive HRT or other health care.
  
• This is called social transitioning.
• This may look like many different things.
  
• Coming out
  
• Changing name - socially or legally
  
• Pronouns
  
• Non-medical changes to physical appearance
  
• Wearing different clothes
  
• Different hairstyle
  
• Binding
  
• Packing
  
• Tucking
  
• Padding
  
• Different participation in gendered activities
  

Coming Out

• Once you’ve figured out your identity, you may want to tell people.
• If you don’t want to tell people or don’t feel comfortable with that, don’t feel pressured for that to be your next step.
  
• There are many ways to come out.
  
• Phone call
  
• Text message
  
• Email
  
• Letter
  
• In-person conversation
  
• Here are 100 ways to come out
  
• You may want to plan what you will say, and how you will respond to questions the person might have.
  
• It’s a good idea to test the waters to see if the person is supportive.
  
• You can do this by bringing up an LGBTQ+ celebrity, asking for their opinion on marriage equality or the current debate about trans rights, and noticing how they talk about LGBTQ+ people.
  
• If the person seems to be homophobic or transphobic, you should consider not coming out, especially if this would put you in danger.
  
• There’s no perfect time to come out, but you can pick a time and place where you are comfortable.
  
• If you have any doubts that the person you are coming out to is not supportive, you should think of a backup plan for what you will do if it goes badly.
  

Coming Out: What to say?

Coming out to loved ones

• “After thinking about it a lot, I’ve realized that I’m nonbinary. This means I’m not a girl or a boy.”
  
• “Since you’re important to me, I want to let you know that I’m trans. I’d appreciate your support.”
  
• “I’ve figured out that I’m actually genderfluid. Can you use (preferred name) and (preferred pronouns) when referring to me?”
  

Coming out at school

• COMING OUT AT SCHOOL: A Trans Guide | ChandlerNWilson
  
• Can write a note or email to teachers - helps to be more discreet and give them time to process your note
  
• “Hi, I’m _____ and I’m transgender. Please use (preferred name) and (preferred pronouns) when referring to me."
  
• What if it doesn’t go well?
  
• If you’re comfortable and safe you can confront people about not using your preferred name or pronouns (or not respond to it).
  
• If you’re not safe because someone is violent or antagonizing you a lot, it’s probably best to let it slide for the time being and talk to someone higher up about it (and if that’s not possible you can talk to people you trust about it and ask them to use your name more around you).
  
• Make sure you know what you want to say in uncomfortable situations.
  
• Can ask friends to help correct people when they don’t use your pronouns.
  
• It’s helpful to go to the LGBTQ+ club (you can ask the administration to create one if there isn’t one).
  

Coming out in a professional environment

• How to come out at work, about anything | The Way We Work, a TED series
  
• Know what you want from the conversation
  
• Set the tone
  
• Give an action item
  
• Eg. ask for a skincare product recommendation for dry skin
  
• “Hi everyone, I just wanted to let you know that I am now using the name ____ and the pronouns ____. If you have any questions about this, feel free to contact me.”
  

Example from Micah Earnes

“Hello All, I need your help. I am in the market for a moisturizer to help with my dry skin. I’m also in the process of coming out as trans. I’m changing my name to Micah, and my pronouns are he/him/his. If you have any questions about my change in pronouns or my skincare needs, feel free to send an email to my updated contact information. And I would also like to note that while my skin is dry, it is not too sensitive. We’re all going to mess up my name and my pronouns, myself included. So when this happens, don’t panic or cringe! Please be kind to yourself as we stumble through these growing pains together. I’m fortunate and grateful to work in a place where I feel embraced in any form, be it as a transgender man or a person with dry skin—or in this case—both.

Trying out pronouns/name

• Using a name and/or pronouns that affirm your gender identity can be very helpful to reduce gender dysphoria.
• There are many options for trying out new pronouns or a new name.
• With trusted family or friends
  
• Online
  
• Pronoun Dressing Room
  
• Subreddit r/TransTryouts
  
• Pronoun Testing Grounds
  
• Explaining pronouns
• General guide to pronouns
  
• Gender neutral pronouns 101
  
• Pronoun practice
  
• Before legally changing your name, it can be helpful to try it out with people you trust.
  
• You can also try out a name at Starbucks to see how that name makes you feel.

Changing your name

Where to update name and sex marker

• Driver's license
  
• Passport/SIN card
• OHIP card
• Birth certificate
• Email address
  
• Banks or other financial institutions
  
• Anywhere online with your credit card information
  
• Any recurring bills you pay
• ODSP/OW/EI and any associated case workers
  
• School/University, including past schools/universities to have a correct transcript
• Student Loans/Ontario Student Assistance Program (OSAP)
  
• Public library or other library
  
• Internet, telephone, and home phone provider
• Any utility services (gas, water, hydro, electricity, etc.)
• Land titles or deeds
• Water heater rental company
• Your landlord
• Place of work
• Insurance provided through work
• Other insurance (life, home, auto, etc.)
• Metro or public transit pass
• Volunteering commitments, especially when a Police Records Check is required
• Sports clubs or teams that you're a member of
• Community centres
• Mental health professional(s) (counselor, psychologist, psychiatrist, therapist, etc.)
• Social worker
• Rewards or points programs (grocery store points card, Air Miles card, etc.)
• Subscription services (streaming platforms, newspapers, subscription boxes through the mail, etc.)
• Job records and professional records
• Records through any professional licensing body, college, or professional association you belong to
• Canada Revenue Agency
• Elections Canada
• Ontario Correctional Services or Corrections Canada
• Will/testament of loved ones
  

How to change common forms of documentation

• Birth certificate
  
• Passport/SIN card
  
• OHIP card
  
• Driver’s license
  

Gender expression

You don't need to have a gender presentation that matches your gender identity, but it may be helpful to relieve dysphoria and feel more like yourself.

Wearing different clothes

• FTM clothing tips
  
• MTF clothing tips
  
• Nonbinary/gender neutral clothing tips
  

Different hairstyle

• FTM haircut tips
  
• MTF haircut tips
  
• Nonbinary/gender-neutral haircut tips
  

Binding

• Binding can help to reduce chest dysphoria for transmasc people by flattening their chest.
  
• There are fabric binders and some people bind with tape that is made specifically for binding.
  

Safety

• Don't bind for over 8 hours a day.
  
• Never sleep in your binder.
  
• Never exercise in your binder.
  
• Never use duct tape or ace bandages, they can lead to serious damage to yourself.
  
• If it hurts, stop.
  
• Only wear a chest compressing garment that is meant for that purpose.
  

Where can you get a binder?

• gc2b
  
• Origami Customs
  
• Underworks
  
• Binder giveaways
• Irisidium
  
• Point of Pride
  

Helpful resources

• Binding 101: Tips to Bind Your Chest Safely
  
• Hudson's Guide: FTM Binding
  
• Chest Binding 101
• How to bind with tape (video)
  
• Binding Safely for Your Body: Tips for All Body Shapes and Sizes
  

Packing

• Packers are penis-shaped products that help to fill in that area for trans guys and transmasc people.
  
• Some people make their own, and others buy them.
• The Ultimate Guide To FTM Packers
  

Tucking

• Tucking is a way to flatten the space between the legs, usually done by trans women and transfem people.
• You can use a gaff, tucking underwear, or tape.
• When using tape, only use medical-grade tape.
• Do not use duct tape, packing tape, or any tape that is very strong.
• Start slowly and be careful.
• If you feel pain at any point, take a break to let the tuck out.
• Never sleep or play sports while tucked.
  
• Tucking guide - Trans Youth Equality Foundation
• How to tuck - TransHub
  

Padding

• Some trans people use padding to help them feel more comfortable with their body.
  
• Some clothes that can help with padding are:
• Padded underwear
  
• Breast forms
• Bras with pockets
• Padded bras
• The Trans Woman’s Ultimate Guide To Bras – urBasics
  

Medical transitioning: About HRT

What is HRT?

• Hormone replacement therapy (HRT) is when sex hormones are given to a transgender or nonbinary person so their body can align more closely to their gender identity, reducing their dysphoria.
  
• Trans men and transmasc people often take testosterone, and these are some of the effects:
• Menstruation stops
  
• Voice deepens
• Facial and body hair growth
• Fat redistribution
• Larger clitoris, vaginal lining thins and becomes drier
• Increased muscle mass and strength
• Trans women and transfem people often take estrogen, and these are some of the effects:
  
• Fewer erections and a decrease in ejaculation
  
• Less interest in sex
• Slower scalp hair loss
• Breast development
• Softer, less oily skin
• Smaller testicles
• Less muscle mass
• More body fat
• Less facial and body hair growth
• There are also many side effects that can occur with HRT.
  
• It's important to talk to your doctor and do research to understand the side effects and figure out if HRT is for you.
• Information about different types of HRT
  

Medical transitioning: Steps to get HRT

Reach out to your primary care physician (PCP)

• They may be able to give you HRT/puberty blockers or they may refer you.
  
• HRT is not a specialty area anymore, so you may not need to see a specialist.
  
• Try providing your physician with resources if they are not comfortable providing you with that level of care.
  
• Guidelines for gender-affirming primary care with trans and non-binary patients
  
• Primary Health Care for Trans Patients
  
• There is also training offered by the Rainbow Health Organization (RHO) for physicians.
  

1

“I understand that you are uncomfortable prescribing HRT. Would you be more comfortable after reading these resources or taking a course from Rainbow Health Ontario?”

What if you don't have a PCP or they are not trans-friendly?

• There are many places where you can find a primary physician.
  
• You can google it online.
• If you live nearby, you can contact a clinic below:
• Sherbourne Health (Toronto)
  
• Integra Health Centre (Toronto)
• Centretown Community Health Centre (Ottawa)
• If you live in Hamilton, you can contact the Hamilton Trans Health Coalition to connect you with a doctor.
• Connect Clinic offers telemedicine consults about trans health care and is covered by OHIP.
• Another option is a referral to an endocrinologist, a type of physician that specializes in hormones.
• Some endocrinologists you can try contacting are:
• Dr. Raymond Fung
  
• Dr. Olaxandra Koshkina
  
• Dr. Eva Kogan
  

2

3

Starting the process

• Wait times are often long, especially since the delays caused by COVID-19.
  
• You will likely need to be in contact with a therapist, psychologist, or psychiatrist.
• They will need to confirm that you have gender dysphoria for you to start treatment.
• There are so many resources available on the RHO website.
  

Insurance

• Many types of HRT are covered by insurance, especially for youth under 25 with an OHIP card.
  
• To check if a prescription is covered through the Ontario Drug Benefit Program, you can search for it on this website.
• If you are denied coverage for procedures or prescriptions covered by OHIP after obtaining doctor referrals and showing your valid health card, consider the following:
  

4

“I am covered by the province of Ontario for __________ seeing that I am a youth under 25. If you are unsure of whether or not the prescription is covered, we can search it on the Ontario website.”

Medical transitioning: Surgery

Surgery is less likely to be done for teens, however, this information can still be useful.

• FAQ for transition-related surgeries
  

Starting the process

• You will need an assessment(s) to get surgery.
  
• Assessments can be performed by:
  
• Physician
  
• Nurse practitioner
  
• Registered nurse
  
• Psychologist
  
• Registered social worker (master’s degree)
  
• Upper surgery - needs 1 assessment
  
• Lower surgery - needs 2 assessments
  
• Next, you will need to submit a form (Request for Prior Approval for Funding of Sex-Reassignment Surgery)
  
• Once you are approved by the ministry for funding, you can book a surgery date.
  

Medical transitioning: OHIP covered procedures

Procedures covered by OHIP

• Vaginoplasty (includes penectomy, orchidectomy, clitoroplasty, and labiaplasty)
• Phalloplasty (includes vaginectomy, urethroplasty, glansplasty, and penile and testicular implants)
• Metoidioplasty (includes vaginectomy and urethroplasty)
• Clitoral release with vaginectomy
• Testicular implants with scrotoplasty
• Hysterectomy (removal of the uterus)
• Salpingo-oophorectomy (removal of the tubes and ovaries)
• Orchidectomy
• Mastectomy (includes removal of breast tissue, excess skin, and proper positioning of nipple and areola) (does not include masculinization)
• Breast Augmentation (has strict criteria: must have completed 12 months of hormone therapy with no breast enlargement and remain at Tanner Stage 1)
  

Procedures not covered by OHIP

• Chest contouring/masculinization
• Breast augmentation for people with breast growth past Tanner Stage I after 12 months of hormone therapy
• Facial masculinization
• Facial feminization
  
• Electrolysis
  
• Laser hair removal
  
• Hair transplants
  
• Tracheal shave
  
• Voice modification surgery
  
• Liposuction
  
• Chin, nose, cheek, or buttock implants
  
• Travel and accommodation costs related to obtaining surgery
  
• Supplies related to post-surgery care
  

Additional resources

Social and Emotional Support

• Groups (online and in-person)
  
• PFLAG
  

Helplines

• Kids help phone: 1-800-668-6868
  
• Suicide hotline: 1-833-456-4566 or SMS: 45645
  
• ROCK (Reach Out Centre for Kids): 905-878-9785
  
• The Trevor Project:
• Call: 1-866-488-7386
  
• Text START to 678-678
• Youthline:
  
• Call: 1-800-268-9688
  
• Text: 647-694-4275
• Canadian Trans Lifeline: 1-877-330-6366
  

Resources

• Families in Transition: A Resource Guide for Families of Transgender Youth
  
• Gender-affirming options for gender-independent children and adolescents
  
• OK2BME Trans Resources
  
• Trans Youth Equality - Resources
  
• GLAAD - Transgender Resources
  
• It Gets Better Project - Resources for Trans and GNC Youth
  
• Powered by Rainbows youtube channel
  
• Jammidodger youtube channel
  
• The Trevor Project
  
• Chest health resource for trans people
• Qmunity
  

Non-fiction books

• The Transgender Teen by Stephanie A. Brill and Lisa Kenney
  
• Growing Up Trans
• I am Jazz by Jazz Jennings
• Beyond Magenta by Susan Kuklin
• Queer; the Ultimate Guide for LGBTQ teens by Kathy Belge and Marke Bieschke
• The Letter Q by Sarah Moon, James Lecesne, and Armistead Maupin
  

Fiction books

• Lakelore by Anna-Marie Mclemore
  
• Simon Vs. The Homo Sapiens Agenda by Becky Albertalli
• I Wish You All The Best by Mason Deaver
• The Heartbreak Bakery by A.R. Capetta