How to Start HRT in Winnipeg

As you may already know, hormone replacement therapy (HRT) is important for many trans individuals. Getting access to this for some is life-saving. But how do you get on HRT? This article will cover both going through your primary care practitioner and Klinic.

Klinic Community Health is an organization that provides many health services, including helping you medically transition.

They can help you not only with HRT, but if you choose, referrals for gender-affirming surgeries, seeing a speech language pathologist to change your voice, and getting laser hair removal from the neck up, all for free!

To register, you have two options:

1. Go fill out the PDF on this page, print it, then either:

   • Hand it in via physical mail
   • Drop it off at the front desk

2. Go to Klinic physically, then ask the front desk for the trans health intake form to fill out. They will give you a clipboard, and you can pick up a sanitized pen to the left of the front desk.

Their address is 167 Sherbrook St., and this address can be found at the bottom of the page, under “Contact Us”.

If you feel it’s unsafe to ask for parents for a ride there, and you don’t have a vehicle, here’s what you can do; you can buy bus tickets nearby, then transport yourself to Klinic using the bus routing on Google Maps.

If you’re not familiar with taking the bus, and need some help, check out How to Take the Bus in Winnipeg.

Depending on how you wish to be communicated with, you will receive a phone call confirming that you’re on the wait list.

You don’t need a family doctor to start hormones! Klinic usually is enough to start.

Having one though can speed things up significantly, from four months compared to a year. Klinic will also want to transfer you to your family doctor after a year under their care.

See if you have a family doctor already. If you’re young and it’s safe, you can ask your parents if you do have one.

If its unsafe to ask, or your current doctor themselves may be unsafe, or for any other reason, you can go to the Family Doctor Finder to find a new family doctor.

The recommendations that the author of this article has heard from a nurse practitioner at Klinic, is the following:

• Gemini Medical
• Health Plus
• Our Own Health Centre

Many of the above may not be accepting new patients at this time, especially Our Own Health Centre. They should however still be providing walk-in services, as of writing.

If you get your hormones through Klinic, after a year on HRT, they’ll want to transfer you to your primary care provider. If you don’t have one by that one year however, they’ll still prescribe you HRT.

If you’re younger than 30, Huddle’s walk-in services may be able to provide for you, via medical practitioner appointment. As of writing, Norwood is struggling to find a medical practitioner, but theoretically all Huddle locations are able to prescribe HRT.

For known good locations, this includes Huddle’s Broadway and South Central locations.

This only applies if you’ve found a family doctor. If Klinic gets to you first, you can safely ignore this section.

There are two separate forms for getting estrogen and testosterone. If you’re transfemme, you likely want estrogen. For transmascs, you likely want testosterone.

• Consent Form for Estrogen and/or Testosterone Blocking Therapy
• Consent Form for Testosterone Therapy

Once you’ve read over it, print it and fill it out!

Tip for transfemmes: you can get progestin prescribed with a separate form. It’s best practice to wait for roughly a year or so, before adding progestin to your regimen.

If you know your doctor’s going to be good about prescribing you HRT, you may not need to give them the informed consent sheet.

If the link is broken, you may be able to get the document in the “Health care providers” section of the Trans Health Klinic. This is under “Medical Forms”.

Public libraries have on-demand print services for a fee, if you need access to a printer. For black and white printing, it is 10 cents by cash. If you don’t have change, you can talk to staff and they’ll help you out. Otherwise, if you can meet a peer support worker at Klinic, you can ask them to print it for you.

If you have found a family doctor, you can then schedule an appointment to them!

Some medical clinics may use Medeo, where you can schedule an appointment online. Otherwise, phone calls will likely be an option.

Hand in that sheet at your doctor’s appointment, and say “Klinic wants a doctor to start treatment before they take care of me. The guidelines are on their website and I want to start now if possible.”

If Klinic gets to you first, they will give you an informed consent form to read over and sign.

If the informed consent sheet is signed, your doctor has no reason not to continue with treatment. If they refuse due to inexperience, you can refer them to the following resources, that don’t require any special knowledge or prior experience to follow:

• Klinic’s guidelines:
  • Hormone therapy prescribing
  • Estrogen and Anti-androgen Therapy Guidelines
  • Testosterone Therapy Guidelines
• British Columbia’s Provincial Health Services Authority:
  • Health Professionals landing page
  • Primary Care Toolkit
• International guidelines:
  • World Professional Association for Transgender Health (WPATH) Guidelines
  • Sherbourne Guidelines

These documents, along with extra info, can be found in the “Primary Care & Hormone Therapy” section of the Health Care Providers section from Klinic.

If they deny you treatment (ex. outright, or redirecting you to Klinic anyway) you can explain to them that you legally signed that you are informed, have given your consent, and would like to start treatment.

If they refuse again, you should insist they continue with treatment, or have them find a new doctor that will. This is an ethics violation, and you should report that to The College of Physicians & Surgeons of Manitoba (CPSM).

As Klinic points out on their own health care provider’s page:

[…] we encourage you to support your client by initiating hormone therapy because it’s within your scope of practice as a primary care provider and “there is a potential for harm by denying access to appropriate treatments” (The Standards of Care V7, World Professional Association of Transgender Health, 2011, p.55).

To deny care can cause undue harm to a patient, along with discrimination as you are trans and seeking care for that. If you need a new doctor, go back to the family doctor finder to find a new doctor.

If you need help navigating the complaint process, you can email the Ombudsman, and they’ll be able to help you.

You can also use RateMDs or Review My Doctor to warn others who may be seeking a doctor.

In the process of being on HRT, you will be required to do a blood test roughly every four months. A nurse will take a blood sample usually from a vein in your arm, and will roughly take five minutes.

If you’re squeamish with needles, mention this to the nurse drawing your blood. One strategy is to look away, and attempt to distract yourself. A nurse may ask you questions like “what do you plan to do after?”, which can prove very effective. You may also find that looking at the needle while being inserted is more comfortable. If you know that you faint when your blood is drawn, also let them know.

There may also be food available to help your blood replenish, such as juice boxes and crackers. Klinic has these usually on reserve, so feel free to ask for it!

If you’re low income, and especially if you don’t have insurance, apply for Pharmacare! Pharmacare may save you hundreds of dollars! It bears repeating; hundreds.

Navigate to the article above, for a guide on whether you are eligible for Pharmacare (which is very likely), and how to apply.

If you qualify for the Non-Insured Health Benefits (NIHB) program, you may get gender-affirming medications fully covered. This generally only applies to First Nations people and Inuks. See Who is eligible for the Non-Insured Health Benefits program for more info.

Otherwise, the national pharmacare program should cover some HRT medication expenses. As of writing, estradiol is covered, but not anti-androgens such as cyproterone or spironolactone. It also doesn’t appear that testosterone is covered via the national Pharmacare system, although the provincial Pharmacare system should cover it if you apply.

In order to obtain prescription medication, you’ll need to go to a pharmacy.

Costco Pharmacy is known for having the cheapest prices. You do not need a Costco membership to use the pharmacy; when an employee in the front asks for membership, say you’re going to the pharmacy, and they’ll let you go.

Otherwise, go with a pharmacy that’s most accessible. The price difference is not very big. Prices will likely not matter much if you’re under Pharmacare and/or have insurance.

For transfemmes, expect your first prescription to be roughly $25 for the cost of anti-androgens/testosterone blockers.

These will come in a paper bag, with a stapled receipt. If your living situation is unsafe, make sure to have a stealthy place to store it!

If your pharmacist hasn’t discussed how to take your medications for the first time, read the prescription bottle. It will contain a short snippet, likely saying to take it daily if you’re on oral estradiol.

For transfemmes, your routine may involve taking estradiol at night, and spironolactone in the day to avoid needing to urinate at night.

Although horribly dense and with lots of irrelevant info, your first-time prescription will contain an informational paper about your medications. Along with really scary potential (but very unlikely) symptoms to watch out, it’ll have info on what to do, if you forget to take your medications at specific times.

To help you remember, you can set up recurring tasks in your calendar to make sure you take your medications at the right time.

Once you’ve taken the medication for the first time, congrats! Mark the date, as it will become an important one on your transition journey.

Even if you’re on HRT, you may still wish to talk with Klinic. This is because if you want to be referred for certain health services, you’ll likely want to do it through them.

This includes laser hair removal for the face and neck (sometimes chest), voice training, and upper, gonadectomy, and lower surgeries.

For all the procedures/surgeries that exist, see Community Members — Trans Health Klinic under “Publicly-funded Procedures/Surgeries” and “Procedures/Surgeries that are NOT publicly-funded”.