Specialized care for people who identify as a sexual or gender minority (2SLGBTQIA+)

Horizon Health Network’s team members work with patients, clients, families and each other to create a safe and welcoming environment for everyone, no matter their sexual orientation or gender identity. The acronym 2SLGBTQIA+ stands for two-spirit, lesbian, gay, bisexual, transgender, queer, intersex and asexual.

This section of our website provides safe and easy navigation through the sometimes confusing path in the health system to being your authentic self – a hub for 2SLGBTQIA+ individuals and their families to find information, resources, and community connections in New Brunswick.

Horizon understands how difficult the path to becoming your true self is, and how different the path is for each person. Our goal is to provide the information needed to make this journey a bit easier.


We welcome your feedback. If you have concerns or compliments about your care, please contact our Patient Representative Services.

Gender Affirming Care

At Horizon Health Network, we value gender and sexual diversity. We strive to provide a safe and welcoming health care experience to everyone accessing our services, no matter their sexual orientation or gender identity.

The 2SLGBTQI+ acronym stands for two-spirit, lesbian, gay, bisexual, transgender, queer, and intersex. The plus sign indicates there are many more identities along the spectrums of sexual orientation, biological sex, gender identity, and gender expression. Our team members work with patients, clients, families, and each other to create an inclusive environment where people can access the care that they need to be their most authentic selves, however they identify.

This webpage serves as a central location for information about gender affirming care services available within Horizon Health Network and provides links to several other important sources of information outside of Horizon regarding access to gender affirming care for New Brunswickers.

We welcome your feedback. If you have concerns or compliments about your care or the information presented on this page, please contact our Patient Representative Services.

What is Gender Affirming Care?

Gender affirmation is the process of changing aspects of one’s gender expression (external characteristics) to align with their gender identity (internal experience). There are many possible actions that a person may take to affirm their gender identity. Some of these actions require the assistance of a health care provider and fall under the umbrella of gender affirming care.

Listed below are some common actions that a person may take to affirm their gender identity, and information on how to access these in New Brunswick. Each person has a different path to becoming their most authentic self that may or may not involve the below items, and all paths are equally valid:

Gender affirming care for youth is provided by health care professionals with specialized training in developmental processes, puberty and physical development, evolving identity exploration, legal and social transition challenges, parental and caregiver involvement, and the impact of peer, school, and community environments. If you are seeking care for your child or adolescent, you or the youth can self-refer to the Integrated Service Delivery (ISD) Child and Youth Team within Horizon Health Network, Child and Youth Addiction and Mental Health Services within Vitalité Health Network, or a specialized mental health professional in your area. Additionally, you can also seek a referral to a pediatrician through your primary care provider. For more information about specific providers, see the list of providers below. For more information about gender affirming care for youth, see Gender Creative Kids or BC Children’s Hospital – Gender Resources.

Social affirmations include changes that a person can make on their own to alter the way their gender is perceived by themselves and others. These can be done without the assistance of a health care provider, however it may be helpful to have a provider’s support through these changes. Some social affirmations may include changes to:

  • Name (informally) and/or pronouns
  • Clothing/accessories
  • Hairstyle/makeup
  • Body/facial hair (ex: removal by laser or electrolysis)
  • Bathroom/dressing room type
  • Use of gender gear (ex: binder, packer, padding, gaff, etc.)

Legal affirmations involve changes that a person can make to their legal name and/or gender marker through the provincial and/or federal government. A health care provider does not need to be involved for legal name changes; however, a form is required to be completed by a health care provider for provincial gender marker changes in New Brunswick. If it is not possible to have this form completed by a health care provider, there is a section of the form where a person can request an exemption to this requirement.

There are 3 options for gender markers on government documents in Canada: F, M, or X. A summary of the steps necessary to make these changes is listed below. More information can be found on the Chroma NB website: Legal transition: a visual how-to guide to changing your legal name or sex designation in New Brunswick – Chroma NB

  • Step 1: Change Provincial Documents
    • Provincial documents include driver’s license or photo identification card, Medicare card, birth certificate, etc.
    • For residents of New Brunswick:
      • Gender marker change: Change of Sex Designation (snb.ca) – a form from a professional is required (such as a physician, psychologist, nurse practitioner, registered nurse, or social worker) although a request can be made on the form to be exempt from this requirement
      • Legal name change: Change of Name (gnb.ca) – documentation from a health care provider is not required, but it may be helpful to have an advocacy document written by a health care provider and signed by a notary.
    • For people born outside of New Brunswick:
      • Birth certificate changes must be done through the vital statistics agency where the person was born.
      • If born elsewhere in Canada: Member organizations (statcan.gc.ca)
      • If born outside of Canada, please contact the appropriate local vital statistics agency
  • Step 2: Change Federal Documents
  • Step 3: Update Elsewhere
    • Consider updating name/gender marker in other settings such as:
      • Workplace/school
      • Health care providers’ offices
      • Banks/financial institutions
      • Elections Canada
      • Health insurance or extended health benefits
      • Legal documents (ex: will, estate, power of attorney, etc.)

Medical affirmations involve non-surgical changes that are made with the assistance of a health care provider and may include gender affirming psychotherapy, voice therapy, reproductive care, and hormone therapy.

Gender affirming psychotherapy, offered by some mental health professionals both within and outside of Horizon Health Network, can be helpful in supporting a person through exploring their gender identity and the changes they may wish to make along their gender journey.

Gender affirming voice therapy, offered by some speech language pathologists both within and outside of Horizon, can be helpful in assisting a person to change their voice and speech patterns to be more aligned with their gender. Services from Horizon-based providers are covered by Medicare, but services outside of Horizon are not (however they may be covered by a person’s private health insurance).

Gender affirming reproductive care is still an actively evolving field and there are currently no fertility clinics within Horizon Health Network. At this time the sole fertility clinic in New Brunswick is Conceptia located in Moncton, however there is also Atlantic Assisted Reproductive Technologies (AART) in Halifax. A referral from a physician or nurse practitioner is required to access services at either of these clinics. Services may include fertility preservation by retrieving and storing eggs or sperm for future use and/or assistance with family building. Family building can take many different forms and may include connection with donor egg/sperm, a gestational carrier, or assisted reproductive technologies (ex: in utero insemination (IUI), in vitro fertilization (IVF), ovulation induction, etc.). Fertility treatments are not covered by New Brunswick Medicare, but patients can apply for a one-time grant of up to $5,000 to assist with covering the cost of treatment.

Gender affirming hormone therapy (GAHT) can be accessed through some primary care providers, some of whom require a referral from another health care provider and/or a hormone readiness assessment letter from a mental health professional.

A gender-affirming hormone assessment letter, following WPATH Standards of Care (SOC) 8, is a document written by a qualified health care provider to support a transgender or gender-diverse individual’s access to gender affirming medical treatment. It typically includes the client’s identifying characteristics, results of a biopsychosocial assessment with any diagnoses, the provider’s relationship with the client and history of evaluation or treatment, confirmation that surgical criteria have been met with a clinical rationale, a statement of informed consent, and an offer for care coordination.

GAHT can also be accessed through some pediatricians and endocrinologists, however they usually have longer wait times than primary care providers, require a referral from a physician or nurse practitioner, and may also require a hormone readiness assessment letter from a mental health professional. If a person seeking GAHT already has a mental health provider, they can ask if this person is able to provide a letter for them. Alternatively, they can contact someone from the list below which also provides details on referral requirements for Horizon-based GAHT providers.

All Horizon-based physician and nurse practitioner services are covered by Medicare; services accessed outside of Horizon to obtain a readiness letter are typically not covered by Medicare and require out of pocket payment or payment via private insurance (if covered). There are usually two parts to the fee charged for the letter: one for the consultation session, and one to compose the letter. This is dependent on the individual provider’s practice and people are encouraged to communicate about this with their provider before the initial consultation takes place.

Surgical affirmations include a variety of possible surgical changes that are done with the assistance of several health care providers. To access gender affirming surgery that is covered by New Brunswick Medicare, a referral to a surgeon from a physician, nurse practitioner, or mental health provider with training in gender affirming care, as well as the completion of the Medicare Prior Approval Form is required. For chest surgery, one referral letter is required. For genital surgery, two referral letters are required. A requirement for all surgeries is that the person has access to post-operative follow-up care through a primary care provider or surgeon.

There are many gender affirming surgical procedures available globally, however only some of these are currently covered by New Brunswick Medicare as indicated below. Some private health insurance companies may offer coverage of some costs associated with gender affirming surgery, and people are encouraged to reach out to their insurance provider to check what coverage they may have and the criteria to be eligible for this coverage.

Gender affirming surgeries currently available within New Brunswick include mastectomy (removal of breast tissue) with or without chest contouring, hysterectomy (removal of the uterus) with or without salpingo-oophorectomy (removal of fallopian tubes and ovaries), and orchiectomy (removal of testes). Other genital surgeries covered by New Brunswick Medicare are performed at GRS Montreal, but the individual is responsible for their own travel costs.

  • Feminizing surgeries:
    • Covered by NB Medicare: orchiectomy, penectomy, vulvoplasty, vaginoplasty
    • Not covered by NB Medicare: breast construction/augmentation, facial surgery, tracheal shave, voice surgery, liposuction/lipofilling
  • Masculinizing surgeries:
    • Covered by NB Medicare: mastectomy (chest contouring coverage depends on surgeon), hysterectomy (with or without salpingo-oophorectomy), clitoral release, urethra construction, metoidioplasty, phalloplasty, penile and/or testicular implants
    • Not covered by NB Medicare: pectoral augmentation, liposuction/lipofilling

 

Available Services – Specialized care for people who identify as a sexual or gender minority (LGBTQ2S+)

The following are a list of services provided by Horizon and Vitalité Health Networks and our health partners in the communities we serve.

General Services and Programs

Specialists for Transgender Patient Care

Fredericton Area
Moncton Area
Saint John Area
Northern NB and the Acadian Peninsula