Back in 2016, when the New Brunswick government announced that top surgery would be covered by Medicare in the province, Reid Lodge called Clinic 554, a local trans-friendly clinic, to get a referral. Over the next couple years, they were able to access surgery, and were happy with the results. But in 2018, when they felt ready to seek a referral for a hysterectomy as part of their ongoing transition, the process was far less smooth.
Around that time, Clinic 554 was forced to scale back its treatments. The clinic was facing financial strain due in part to public funding restrictions, so getting a referral was trickier. Then, Lodge’s wait time was extended further by the general healthcare backlog during and after the peak of the COVID-19 pandemic.
During that time, Clinic 544 continued to scale back, and was eventually forced to close entirely in 2024. It was the only publicly trans-friendly clinic in New Brunswick and since then, no other clinic has been able to fill the gap.
Clinic 554’s shrinking and eventual closure caused a break in Lodge’s care—and the care of many other trans people in the province. It wasn’t until 2024 when Lodge finally got their hysterectomy.
Today, Lodge says access to trans-friendly care in the province is continuing to decrease. Since Clinic 544 closed, no alternative hub for queer and trans care has taken its place. While some providers do specialize in LGBTQ2S+ health, they are hard to find: the government’s public list of queer- and trans-friendly providers is out of date, leaving trans patients especially to rely on online community groups or word of mouth to find care. When they can’t get access, they risk stalling or delaying their transitions.
Trans patients and activists in New Brunswick have been advocating for the provincial government to contribute funding to expand gender-affirming healthcare through the funding of a new clinic. But for now, patients are left waiting.
New Brunswick is the only province in Atlantic Canada without a clinic specializing in gender-affirming care. While it’s possible to find some safe spaces where staff respect Two-Spirit, trans and gender-diverse patients’ pronouns and know how to help with referrals for surgery and hormone therapy, they’re hard to come by.
“It’s kind of a crapshoot, depending on which provider you end up with, what kind of care you’re going to get,” Lodge says.
Fredericton, according to Statistics Canada, has one of the highest proportions of trans and non-binary people of large urban centres in the country. Still, according to a 2020 Trans PULSE survey, 64 percent of trans and non-binary patients in New Brunswick had unmet healthcare needs during the previous year.
Finley Rogers is a member of the New Brunswick Transgender Health Network (NBTHN) who has been fighting to improve access to gender-affirming care for a decade. They say an easy-to-find, publicly funded clinic catering to the community would contribute to sustainable care in the province. Their hope is that such a clinic would also focus on education and training for providers.
Clinic 554 used to provide referrals for gender-affirming surgeries and dispense prescriptions for hormone therapy. Staff engaged in advocacy for better care and allowed LGBTQ2S+ organizers to use the space after hours for meetings. It was also the only clinic in the province providing surgical abortions, which some patients prefer because they’re faster, and performed under the supervision of healthcare providers.
Clinic 554 was not around for very long: it opened in 2015, in part thanks to crowdfunding. But legislation in the province’s Health Act put the clinic in a tough financial spot. Regulation 84-20 prevented doctors from billing the province for abortions performed in clinics, so patients were forced to pay about $800 out of pocket for the procedure. Sometimes, when patients couldn’t foot the bill, the clinic would offer procedures pro bono.
For years, advocates tried to save the clinic by fundraising, protesting and lobbying the government to change its policies. But successive provincial governments, both Liberal and Progressive Conservative, refused to repeal Regulation 84-20.
Though no dedicated clinic exists now, gender-affirming care is available in and covered by the province. Doctors, therapists and nurse practitioners can help patients access hormone replacement therapy (HRT), and New Brunswick now covers both HRT and gender-affirming surgeries. But only a handful of people are known for doing this work, and most providers lack the training needed to offer trans healthcare. Another problem, Rogers explains, is that there’s no billing code for gender-affirming care for fee-for-service doctors, meaning they can’t bill for their time for these appointments. Doctors can use billing codes for different types of appointments, such as sexual healthcare, but if appointment times run longer than 15 minutes, providers end up working at least partially pro bono.
“Gender-affirming care is clearly not happening within primary care for most patients,” Rogers says. “The current situation is not sustainable, and it’s failing our patients and our providers.” When people hit a barrier while they’re looking for a practitioner, they say, it can be easy to just give up.
At the tail end of 2024, trans and gender-diverse people hoped things might change. When Progressive Conservative premier Blaine Higgs was unseated in November of that year, it seemed like Susan Holt’s new Liberal government was going to do something about limited abortion and gender-affirming care in the province. Prior to being unseated, Higgs drew national attention with Policy 713, an amended education policy which forced trans students under 16 to obtain parental consent before having their pronouns and any name changes respected at school.
Unlike Higgs’s government, whose 2024 election platform on healthcare was vague, Holt campaigned on promises to improve healthcare in the province by establishing and supporting 30 community care clinics. The Liberals also promised to “ensure billing process aligns with best practices to provide members of the LGBTQ2S+ community with quality health and mental health care—including longer appointment times and gender-affirming care.”
As soon as she took office, Holt struck down Regulation 84-20, meaning clinic-based abortions could be performed in the province. In her mandate letter to health minister John Dornan, she said billing practices needed to align with best practices for gender-affirming care. She also swiftly reversed Higgs’s changes to the province’s education policy. Because of Holt’s campaign promises and outward support for trans and gender-diverse people, trans people hoped that her government would also invest in a new dedicated LGBTQ2S+ clinic.
So far, that hasn’t happened. Victor Reap, a peer support coordinator with LGBTQ2S+ advocacy group Chroma NB, says this matters because trans folks aren’t often able to get the care they need from their family doctors. Some providers even refuse to treat trans patients, mostly because they don’t know how, Reap says. “Trans people have to deal with educating their doctors about their own treatment, which is frustrating. A lot of providers don’t know what they can actually do.”
A clinic specializing in gender-affirming care would mean patients could stop spending so much time searching for basic healthcare. It would also mean they could move forward with their transitions at the pace that feels right for them, which leads to better mental health outcomes.
Some healthcare providers have tried to step in and do what Clinic 554 did. When Clinic 554 closed, Keltie Keir, a Fredericton-based nurse practitioner, took on many of its patients, prescribing hormones and giving people referrals. Lodge was able to get in as one of her patients.
Keir, who is queer, started learning about healthcare for trans people in 2020. In order to build her skills, she completed WPATH (World Professional Association for Transgender Health) training online and went to conferences focused on the topic. It wasn’t long before she became a go-to person for the community. “I quickly realized that, due to the lack of affirming providers, I had to navigate most of the learning on my own and then jump in.”
Keir says by the time many patients find her, they’ve spent years searching for a provider. But even then, her practice remains inaccessible to some, as it’s a private practice—so the 500 trans and gender nonconforming patients she sees virtually must pay for care. “Fee for service is not how I want to practise,” she says. But because nurse practitioners can’t bill Medicare for their services, she doesn’t have a choice at the moment.
The situation could soon change. In 2025, the federal government ordered the provinces to give nurse practitioners the authority to bill for all medically necessary care services, including the ones Keir offers. Once that happens, Keir plans to open a queer-friendly clinic and hire more LGBTQ2S+ providers.
New Brunswick’s current trans healthcare situation is not for lack of advocacy. NBTHN, Chroma NB and queer rights group Alter Acadie pushed for a clinic to be covered in the province’s latest budget, announced in March. The budget includes the largest investment in healthcare in New Brunswick’s history, with $710 million more than the previous year’s budget dedicated to health spending, and $30 million earmarked for the expansion and creation of collaborative care clinics. Yet the budget contains no commitment to funding a clinic that could provide desperately needed expanded access to gender-affirming care—nor does it provide any dedicated funding for the expansion of LGBTQ2S+ care more broadly.
After the budget was announced, NBTHN issued a statement stressing it would only have cost 0.04 percent of the total health budget to build a gender-affirming-care clinic and program.
Rogers says they weren’t expecting such silence around the issue. “There was a degree of openness. So it was surprising that nothing was mentioned anywhere [in the budget].”
Script reached out to health minister John Dornan—who himself previously worked as an endocrinologist serving trans people in New Brunswick—through his office via email. In the email, Script asked whether the provincial government planned to financially support a gender-affirming-care clinic in the future, and what else was being done to help providers learn more about caring for trans patients. A communications staffer with the provincial Department of Health eventually passed along a statement from Dornan.
Dornan said that the health department is working with regional health authorities to “identify opportunities to enhance access to gender-affirming care within their operational budgets,” and that a gender-affirming healthcare advisory committee has been established to work toward more improvements.
The health department is also funding Alter Acadie’s bilingual 2SLGBTQIA+ Provincial Health Summit in October, which Script will be presenting at. Dornan says the summit will aim to “identify avenues for action.”
He didn’t address Script’s question about a clinic.
The Liberal government has introduced other positive changes to trans healthcare in New Brunswick. Last October, the eligible age for chest surgery was lowered from 18 years to 16 years, and a memo was sent to plastic surgeons in the province to be sure they understood that liposuction done as part of chest surgery is covered by Medicare. Previously, trans patients were required to get two letters of referral from healthcare providers before accessing bottom surgeries; as of last fall only one is needed, bringing the province closer in line with WPATH standards and other provinces like B.C. and Quebec. The province held gender-affirming care workshops for nurse practitioners as well.
Breast augmentation was also added to the list of surgeries covered by the province’s healthcare plan. For the procedure to be covered, it must be performed in a public hospital setting, however. Rogers says that to the NBTHN’s knowledge, only one surgeon is performing breast augmentation at a public hospital, and patients who go elsewhere must pay out of pocket, meaning that while the change is a step in the right direction, it doesn’t improve access for everyone.
Additional components of surgeries, including travel, hair removal before bottom surgery and liposuction after top surgery in some cases remain uncovered, meaning some patients still need to pay thousands of dollars of their own money. And for some bottom surgeries, patients need to travel out of province, usually to Montreal.
And advocates continue working to correct the lag in care. Chroma NB held a workshop in June for healthcare providers and clinic staff to learn to better care for the community, with another scheduled for the fall. They’re also creating a map people can use to determine how to access surgery.
Lodge, for their part, is lobbying for government-funded healthcare expansions, and they hope to see those take shape.
“I feel like a lot of trans people would have better mental health outcomes if they weren’t so stressed about access to this care all the time.”
This article was co-produced with Xtra Magazine, Script's sibling publication.
