Lost in transition: A transgender woman’s struggle to access hormone therapy in Burnaby

Riley Willson was fuming.

“I feel like I’m never fucking going to be allowed to be myself,” she wrote in a post online after hearing back from the Three Bridges clinic in Vancouver.

After two years of trying to access hormone replacement therapy (HRT), the 25-year-old faced yet another setback.

Three Bridges is a primary care clinic in Downtown Vancouver that provides care for marginalized and vulnerable communities with “complex psychosocial and clinical needs,” and its services include a transgender specialty care program.

Through that program, transgender individuals can access HRT, which uses estrogen or testosterone, depending on a person’s assigned sex at birth, to medically transition to the gender they identify as.

After applying to access hormone replacement therapy at the clinic, she was met with a brief message: “Due to your location and/or age, we need to redirect you to other provincial services.”

Willson lives in Burnaby; the clinic only serves clients who live in the Vancouver Coastal Health region.

What made this all so frustrating for her was that she’d been directed to that clinic by a psychiatrist at Burnaby Hospital after months of trying to get a referral to access hormone replacement therapy.

Willson’s story is indicative of how damaging barriers to accessing transgender healthcare remain for many of those who need it—particularly if you live east of Boundary Road—even as access has improved over the last couple of decades.

The process of coming out

Willson came out as transgender to various social and familial circles in stages over the last two-and-a-half years.

She described her friends as being “very supportive” of her when she came out, and her family was “very accepting,” although it’s still taking some of them time to process and adjust.

And about four months ago, she came out to her two hockey teams, who she said were also “extremely supportive.”

In that sense, Willson is one of the luckier ones, as some in the LGBTQ2S+ community continue to face troubling circumstances when coming out to loved ones.

For Willson, who described herself as having a “really bad” anxiety disorder, the challenge in coming out was finding a voice for the words she wanted to say.

“The gathering-the-courage part has been more of an issue for me than how people have received it,” she said.

A stalled transition

Asked whether she would consider herself to be in the process of transitioning or whether she’s stalled at the starting point, Willson said the word can have a number of meanings.

“When I first asked about [hormone replacement therapy], I more asked as a means to explore the possibility. Because at the time, I felt dysphoria about my body,” she said, but she added that she’d been living with that dysphoria—the distress one feels from the disparity between their physical body and their gender identity—for over 20 years.

“At that point, it’s kind of just going through the motions, and as much as it does extremely affect my mental health, there’s also the worry about what transitioning my body will do to things socially, like interacting in workplaces and stuff.”

And transitioning can take any number of forms. Some people undergo hormone replacement therapy; others don’t. Some seek gender-affirming surgery; others don’t. Some, for a variety of reasons, do neither.

For Willson, the decision of whether to medically transition has been an ongoing calculus, weighing two opposing variables: “how bad does it feel to be invisible versus how bad do I imagine it would be to be visible?”

Weighing the variables

That calculation, and how each variable is weighed, is different for everyone.

Lisa Salazar, a volunteer with Pflag Vancouver, transitioned 14 years ago, at age 58, and it took her close to a decade after she was first assessed by a doctor for her gender dysphoria in 1999.

Salazar has advocated for years for trans rights, including access to care, and she noted that some have greater urgency to transition.

For trans youths, for instance, it may be more crucial to start puberty blockers quickly, as it can pre-empt a much longer process of transitioning later in life.

“They don’t want to go through the wrong puberty. They don’t want to grow facial hair, if you’re a trans girl, or they don’t want their voice to change,” Salazar said.

And some older people may experience greater urgency due to the severity of their dysphoria.

Still, there remains the other side of the calculation Willson mentioned.

“It’s extremely scary to be visibly trans,” she said. “Part of reaching out to get HRT was to start seeing the other side of the calculation because I’d always kind of done it on speculation; I’d never really gone through the process of seeing what it would entail.”

But now that she’s started down that path, she’s hit roadblock after roadblock. And she said she would “absolutely” have reconsidered how and when she came out as transgender had she known it would have been this difficult.

Two years of trying

Willson has been trying to access gender-affirming care for two years now.

“I’m still in the exact same spot I always was,” she lamented.

It started with her primary-care provider (PCP), the family doctor she’s seen since she was born.

Willson’s doctor had found a clinic that provided hormone replacement therapy, but it required a referral from either a family doctor or a psychiatrist.

"They’re your [resource] to get from point A to point B. And I’ve basically been … run around a hamster wheel.”

Photo: sfam-photo / Shutterstock

“My family doctor—I don’t know why, exactly, but he said he wasn’t very experienced with it, so he didn’t feel comfortable giving a recommendation,” Willson said.

Instead, Willson’s family doctor helped her get an appointment with a psychiatrist at Burnaby Hospital through Fraser Health.

After going through intake with the Burnaby ​​Mental Health and Substance Use Centre, she was met with roadblock after roadblock, each with its own months-long waiting period.

She waited five months to get an appointment over Zoom, but when the time for that appointment came, the email with the Zoom link never arrived in her inbox.

And after she missed a follow-up call a week later, Fraser Health never followed up again.

“So that was extremely disheartening,” she said.

Another denial

After taking some time to process that setback, she tried again and got another appointment through her family doctor with Burnaby Mental Health.

But that appointment got off to a bad start after it turned out, through a miscommunication between her family doctor and the Burnaby Mental Health psychiatrist, that she was referred for anxiety—not for accessing hormone replacement therapy.

And once that got sorted out, she was still met with resistance. While the psychiatrist believed her that she was experiencing dysphoria, he also declined to provide her with a referral.

“Because he [would have given] the recommendation, he gets the medical paperwork from the lab or whatever, and he doesn’t want to deal with that,” she said.

In an emailed statement to the Beacon, Fraser Health said it works with patients “to facilitate access to specialized services that are available within our region.”

“Additionally, if a patient requires referrals to programs outside the Fraser Health region, we will support them in making these referrals and by providing the necessary information to facilitate proper assessment, treatment, and transition of care,” the health authority said.

“In general, we would not decline a patient a referral for administrative reasons.”

Pointed to Three Bridges

Instead, the psychiatrist pointed Willson to the Three Bridges clinic, which he’d previously worked at and which doesn’t require a referral from a medical professional.

“Tons of trans people talk glowingly about it, and it seems like a great place,” Willson said.

“It’s kind of the place to go for trans people to get treatment, unless you’ve got the money to dish out for a private consultation and to dish out for the HRT. … That’s the place to go if you’re not made of money.”

But it can also come with a waitlist. Vancouver Coastal Health, which operates the clinic, told Burnaby Beacon the current waitlist is estimated at three to four months, but Willson had heard from friends that they had waited far longer than that.

And there was one more snag for Willson—they don’t accept patients from outside of the VCH region.

“It was really disheartening to go to someone who should be able to navigate the health system for you because they’re your resource, they’re your place to get from point A to point B. And I’ve basically been … run around a hamster wheel.”

Setback after setback

Willson isn’t entirely new to trying to navigate a labyrinthine healthcare system—she’s experienced similar runarounds when trying to access mental health supports.

But it’s nevertheless exhausting and frustrating.

“All I really want is to live in a body that’s closer to what would make me happy, and I don’t feel like it should be such a Byzantine maze for me to get there,” she said.

For Willson, the effects of these roadblocks haven’t simply been the sum of their parts. It isn’t just about the time wasted on that effort and the time that will be spent on the next effort—there’s an emotional toll that eats away at her confidence that it will ultimately work out.

“I placed a lot of importance on that deadline,” she said of her first missed appointment with a psychiatrist.

And she was thrown through that loop numerous times—getting an appointment and setting a deadline, only to have it pushed back further.

“I wish there was a little more care put into making sure that people get what they need.”

“I’m like, ‘OK, after I get this, I can start taking hormones. I can start telling people that I am making progress to becoming what I want to look like,’” Willson said.

“I can start to plan my life around when I will get these changes or get these changes, and when it just gets completely thrown out the window, and my deadlines become infinite, … it doesn’t feel like just being stalled. It feels like my whole life has been thrown apart.”

‘Stuck in stasis’

Every setback means she continually has to face her friends and family with a body that feels more like a cage than a home. And every time she meets someone new, she has to go through the process of coming out yet again.

“It’s really hard to explain to someone, and for someone to understand, that yeah, I’m trans, and yeah, I plan on looking different, but I have no idea when that’s ever going to be—and that might never be,” she said.

“It’s really difficult to get across to people what they can expect from me and being able to talk to my friends about it because I’ve kind of just been stuck in stasis, from their perspective. … I think it’s kind of gotten difficult for them to see me as I am, rather than what I was, because there hasn’t really been the changes that I wanted and that I communicated to them.”

She notes that that doesn’t delegitimize a trans person who doesn’t medically transition, but she, personally, continues to experience dysphoria.

Trans care is vital

Access to transgender healthcare can be life or death.

“After that appointment, I felt suicidal for months, and it was really, really difficult to survive day to day with the amount of hopelessness I felt,” she said.

Willson isn’t alone. Transgender people—especially trans youth—are at a higher risk of suicide. According to one study published this year, trans adolescents showed five times the risk of suicidal ideation and 7.6 times the risk of suicide attempts.

But studies have regularly shown that access to a medical transition can mitigate suicidality.

One massive study published last year found that access to gender-affirming therapies for transgender youth vastly reduces the risk of suicide.

In people under 18, access to HRT was associated with a nearly 40% drop in risk of depression or suicide attempts in the previous year compared to those who did not have access to hormone therapy.

And for Salazar, it was thoughts of death that finally pushed her, seven years after she was first referred to a gender clinic, to seek gender-affirming care.

“It sounds overly dramatic and [like] hyperbole, but I was thinking about this all the time. I wouldn’t say that I was suicidal, but I was thinking, ‘Oh, this would solve so many problems, and it’d be so much easier on my family, and nobody would ever need to know,’” she said.

“I was negotiating with God, kind of like, ‘When I am jogging one day, have a large tree limb fall from the sky and kill me instantly.’”

And years later, after transitioning, she became an active and vocal advocate for the trans community.

Transgender care across Canada lagging

Their experiences aren’t entirely uncommon either. Last year, LGBTQ2S+ news outlet Xtra published a lengthy piece on Canada’s “chronically underfunded trans-affirming clinics.”

That article notes that it’s hard to tell how many LGBTQ2S+-friendly clinics there are in Canada, and it starts with an anecdote that resonates with Willson’s experience about a trans man seeking to transition.

“My GP at the time had no clue [about the transitioning process] and didn’t even appear to want to learn,” he is quoted as saying in the opening paragraph.

While trans people in Vancouver can access things like Three Bridges, they still experience wait times. Salazar said this is the problem she hears most commonly from people seeking to transition.

And once you cross Boundary Road, access is limited to those who can get a referral.

Willson isn’t entirely sure where to go from here. She’s hoping her family doctor will reconsider, but that’s far from a sure thing—and finding a new family doctor is notoriously difficult in BC.

Salazar said Trans CareBC, a service through the Provincial Health Services Authority, is the best place to go.

But for now, Willson is still building up the courage to make another attempt after facing so many setbacks.

“I wish that health providers would recognize that when people come to you, this is a significant thing for them, and their life is—maybe sometimes metaphorically, sometimes maybe literally—in your hands,” she said.

“I wish there was a little more care put into making sure that people get what they need.”

Get Burnaby Beacon in your inbox.An in-depth understanding of the stories that affect Burnaby and beyond, every weekday.