Hi all!
I've been seeing lots of posts here lately asking things like "I'm 17, can I get HRT?" and I thought it would be helpful for this subreddit to have one big thread to address that question. Below I've started writing some things, and I would like to know if anyone would be interested in adding on to this post (via comments and I'll add it later) so we have an up-to-date resource. I've done my best to only include information I know to be verifiably true, but please correct me if I have something wrong!
Disclaimer: None of us are acting as professional doctors or lawyers in this thread, so take our advice as the words of people who have experienced this, not as medical or legal advice.
Now, onto the questions and information:
"I'm a minor. Can I get HRT?"
Yes!
HRT in Ontario works on informed consent model, which, essentially, means that as long as you can understand the risks and benefits of a decision, you can make that decision.
Informed Consent does not explicitly outline an age where you are "able to make decisions". Therefore, it's up to your healthcare provider to assess your capacity to consent. In general, doctors are good about this, and as long as you know what the risks are, they'll give you the prescription.
"Will my parents know?"
The short answer is "if you don't want them to, then they won't". The long answer is more complicated than that. Let's start with getting the appointment:
Now that virtual appointments have been very unfortunately axed by good 'ole Doug Ford, in-person appointments are back to being some of the only options. In person appointments are obviously much more difficult to hide, as you need to physically go into the office and they often take longer.
Now, the ideal scenario is to explain to them what is going on and get their support, but obviously that doesn't work for everyone. If you're really in a pinch, lie. Make up symptoms that would send you to the doctor, and once you're there, explain the real problem. Often a great way to do this is to complain of symptoms of depression/anxiety, get a therapist, then talk about gender shit instead. This is not a recommended pathway. This is not sustainable. You have been warned.
In terms of your doctor blabbing to your parents:
Doctors are not allowed to disclose any personal information to any other person***
Patient privacy is a complicated beast, so I'll do my bets to explain here. According to PHIPA Section 23.1.i, any person, regardless of age, can decide to disclose or withhold medical information as long as they meet the criteria for informed consent. By default at a family doctor, your parents might be set up to know about your medical care. You have the right to remove them at any age as long as you understand the consequences of doing so. Ask about it. Voice your concerns. Self advocate.
The only time a doctor has to share your personal information comes in one of five circumstances:
"There are times the doctor has to breach confidentiality???"
Yes. There are five instances in which a doctor is allowed to disclose your personal information without your express consent (these are the same as a therapist, if you're interested). These apply to all patients, regardless of age:
- If the information is requested by a law enforcement agency or a court (as part of legal proceedings)
- This won't come into play for 99% of people, but if a court subpoenas information from your doctor, they are legally required to provide it.
- If there is neglect by another medical official (doctor, dentist, therapist, nurse, support worker, etc).
- Your care provider is required to inform the relevant authority (usually a medical board) so they can face disciplinary action.
- If you have intention to commit a crime or cause harm to another person.
- The standard here often requires an actual plan, and for it to be reasonable that you would actually carry out the act. Simply saying "sometimes my brother makes me angry and I want to hit him" would not invoke this exception because there is no direct plan, nor is there an indication that the action would be certain to be carried out.
- You have an intention to harm yourself
- This is by far the most controversial exception. Legally, your care provider is required to inform the authorities (usually police) if you intend to hurt or kill yourself. Most physicians understand that suicidal ideation (thinking of suicide) and having a suicide plan are different. This exception should only be invoked if there is a plan for self harm or suicide, not if there are thoughts or previous instances of it, however, it is always best to gauge what your physician will report.
- If there is evidence or reasonable suspicion of abuse or neglect of a person under the age of 16
- This includes sexual, emotional, physical abuse. Your physician has a duty to report it to either the appropriate children's aid society or abuse reporting centre. Same as #4, there can be situations where this gets tricky, and healthy doses of good judgement are in order
In general, you should always ask what information can be shared, and always ask questions surrounding consent and patient privacy.
Your doctor has to answer this, and they will often be eager to explain this as it's a very, very important part of practicing medicine.
"I thought you had to be sixteen to consent to treatment and remove parents from patient information?"
So did I, friend. But, as u/stacyah helpfully pointed out, this is not true. The confusion stems from a part of the code that says that at sixteen years of age, you can designate a person to be privy to your health information. However, you are able to decide who knows what at any age, as long as it's within the exceptions above.
I'm 12/13/14? Can I still get HRT then?"
Absolutely!
Informed consent does not have a defined age range. If you are able to consent, you are able to receive treatment. Obviously, there are added social challenges the younger you are as you seek transition care. However, legally speaking, there should be no additional barriers for you seeking treatment.
"Will I have to pay for anything?"
If you are eligible for OHIP, all consultations with your doctor will be free. Always bring your health card to your visits.
Drugs are first checked with your insurance provider, so if you have an open file with a pharmacy and they have a parents' insurance it will always go there first. If you aren't covered by private insurance and you're under 25, you're eligible for OHIP+, which you can learn more about here. There is still sometimes a co-pay with insurance, which can be frustrating. Typically though these costs are low ($5-$10). Seeking injected estradiol specifically also incurs an additional cost as you have to visit a compounding pharmacy, which is typically more expensive than your regular Costco or Rexall.
There are also two other relevant programs, the Ontario Drug Benefit and the Trillium Drug Benefit. These are based on income and can be accessed by residents over the age of 25. You can learn more about the Trillium Drug Benefit here.
This link will allow you to check the eligibility of most medications in Ontario.
Covered by OHIP+?
| Estradiol (oral) |
Covered |
| Estradiol (injected) |
Not covered |
| Estradiol (gel) |
EAP Only* |
| Estrogen (patches) |
Unknown |
| Progesterone (oral) |
EAP Only* |
| Testosterone (oral) |
Covered (link) |
| Testosterone (injected) |
Some Restrictions, can still be covered |
| Testosterone (gel) |
Covered |
| Cyproterone/Bicalutamide/Sprionalactone |
Covered |
*Covered only under the Exceptional Access Program (https://www.health.gov.on.ca/en/pro/programs/drugs/eap_mn.aspx#:~:text=The%20Exceptional%20Access%20Program%20(%20EAP,Drug%20Benefit%20(%20ODB%20)%20program%20program).)
Hope this helps, and please feel free to add anything I missed in the comments!
Thanks to u/stacyah and u/Valtharius for the information about informed consent!
Edit 1: Fixed lots of info about informed consent. Thanks u/stayah and u/Valtharius for the help!
Edit 2: Formatting and updates to drug coverage/how OHIP works
