How Can Patients Access HRT in Montreal?

It can be very difficult to access HRT in Montreal due to the healthcare systems’ limited appointments, the unwillingness of most GPs to prescribe HRT, the lack of education on gender-affirming care in medical schools, general lack of resources in the health system, the poor and outdated practices of providers, and discrimination. 

However, there are several strategies to increase the chance that you will be able to access HRT. This document aims to describe some of the key strategies that we have used to help  patients access HRT in Montreal. 

Preamble: New to being a trans patient? Advice and Information

1. You may very well have an incompetent HRT provider, the more educated you are on standards of care and the more you learn to self-advocate the better off you will be

Any GP (family doctor) in Quebec can prescribe HRT, but the vast majority will refuse to do so if asked. There is no systematized education on trans people and gender-affirming care in medical schools, most GPs don’t believe it should be their responsibility to learn how to provide HRT, and GPs have limited time to learn if they are interested. Still, there are a lot of guides and workshops available to teach interested GPs how to prescribe HRT. Because there is little systematized training on HRT and gender-affirming care, even many doctors with hundreds of HRT patients will have big gaps in their knowledge on HRT and gender-affirming care, and will use outdated and discriminatory care practices. 

Because of this it is in your best interest as a patient to learn as much as possible about what good practices are and understand the science so that you are able to advocate for yourself. It can be extremely helpful to learn to be able to politely but firmly stand up for yourself with your providers, and being clearly educated on the science will help you in this self-advocacy. Even being aware of the practices of other providers and standards can help: ‘Doctor could you explain to me why you require this document, the WPATH standards of care don’t say anywhere that it is necessary, and I know Dr.X at Y clinic doesn’t require this’. Unfortunately, some patients will be much less well positioned than others to self-advocate and be taken seriously by doctors. For example, if you are a POC, a minor or look young, someone with a disability, neurodivergent, or dress in alternative fashion or ‘non-comformingly’ etc.. many doctors will unfortunately be less likely to be amenable to your effort to advocate for yourself. 

As many HRT providers are incompetent, if your provider says something that sounds suspicious, it may very well be – you should look into it. You should do your own research, and talk to other patients when you have suspect experiences, or ask for a second medical opinion when applicable. 

2. Learn about RAMQ’s coverage and your insurance options

Be sure to educate yourself on your insurance options, your providers will often not be. For example, many HRT doctors do not know that fertility preservation is largely covered by RAMQ for those planning to start HRT, all you need is a provider’s referral to one of the private clinics in Montreal that do this. RAMQ covers HRT and many gender-affirming procedures (although not those they consider ‘aesthetic’ such as laser/electrolysis and facial feminization/masculinization surgery and breast augmentations or partial breast reductions). If you are a university/CEGEP student, have a job with good insurance, or are a dependent/partner of someone with good insurance, you may have additional coverage for gender-affirming care coverage not offered by the province. Generally these additional insurance will only cover what the provinces do not. 

3. Being proactive and trying a variety of methods to get care can help, but sometimes there are so many delays and it’s not fair

Since there are so many delays in access care, it’s in patients’ interest to be as proactive as possible in accessing care. You can always get off a waitlist or cancel an appointment very easily if it turns out you don’t want the service. But if the only clinic you are on a waitlist for ghosts you, getting back that lost time is not really possible. Unfortunately, some delays can be infuriatingly unfair and out of patients’ control, for example sometimes waitlists are frozen for months, sometimes most clinics are not accepting more people to be added to their waitlist, or clinics lose their HRT waitlists altogether. This is why we recommend getting on as many waitlists as possible and trying as many paths as possible because some of those paths will be dead ends. Trying different paths can take up a lot of time and energy, and that is also not fair. 

4. Interested in surgery? Look up your surgeon

If you are interested in getting a gender-affirming surgery at GRS Montreal (surgery clinic covered by RAMQ) or elsewhere research your surgeons as much as possible ahead of time using reddit, transbucket and other forums. Ideally you want to be confident that your surgeon has a record of consistently delivering the results you want. (Although approach forums and subreddits cautiously, among their many problems medical complications are often way over emphasized as they get the most engagement). 

At the TPU we also provide a service where we will connect a patient who wants a surgery to a patient who has had that surgery. So reach out if you are interested. 

5. If possible, get a circle of HRT patients or trans friends who can support you

If at all possible, make friends with, talk to, and take notes from other HRT/trans patients. They can help you identify red flags and be a supportive ear when you are struggling to access care. Their experiences, advice, and support can be invaluable for effectively navigating healthcare while trans with your sanity intact. If possible attend trans community events, there are a lot of social groups for trans people in Montreal and there will very often be people there who will be able to give you advice or help you find someone who can give you advice. If in-person community is not an option for you, forums and discord servers can be good resources. In particular, FEMTL has a good large discord server for transfeminine people where peer support is often provided. Jeunesse Lambda has a community discord for trans youth as well. 

6. Struggling to access a family doctor? Sometimes other services can help

• 8-1-1 (Primary Care Access Point) is a 24/7 phone line in French and English which can book walk-in appointments and generally direct you where you need to go if you are struggling to figure out where to access care. Although they are certainly better for matters other than gender-affirming care. 
• Pharmacists can often prescribe some medications or let you know if a health issue is serious enough to warrant seeing a doctor. 
• RVSQ, et ClicSanté are the two main portals for booking appointments for health services in Quebec

• While some doctors like to pretend otherwise, medical records always belong to the patient. You have a right to access your records and request they correct erroneous information in your medical file where your doctor takes notes. 
• Irrespective of your legal name or gender – Canadian human rights legislation is meant to include protections for you, including in the medical system! You have the right to: be referred to by the name and gender you want, expect reasonable accommodation, not be subject to discrimination, harassment or offence due to your gender identity / expression, and equal access to housing, employment, government services and private services. 

7. Common issues HRT patients face to be aware of:

• Difficult logistics in getting on clinic waitlists or booking appointments, many clinics do not pick up their phones, have closed their waitlists, or have waitlists over a year long. 
• Doctors keeping patients on low or ineffective HRT doses
• Doctors doing a poor job of discussing fertility preservation – either misinformation, glossing over it, or implying it is compulsory (especially for trans youth). Keep in mind fertility preservation is covered by RAMQ for those starting HRT. 
• Incorrectly interpreting a patient’s blood test results, especially if a patient is using an HRT administration method the doctor is less familiar with. 
• Misgendering, deadnaming, or offensive comments from providers and clinic staff
• Family doctors not knowing trans-informed specialists to refer patients to, for example gynecology for trans masculine patients on testosterone or transfeminine patients with neo-vaginas. 
• Doctors requiring that patients see a psychologist or get a gender dysphoria diagnosis. Both of which are not in line with the informed consent model recommended by most standards of care, it is completely unnecessary and outdated. 
• Telling patients they need to see an endocrinologist to receive HRT. An endocrinologist’s specialist knowledge is not typically required for HRT. As endocrinologists are specialists, they usually have long wait times and can be hard to book appointments with. And while they are hormone experts many are not educated on other aspects of gender-affirming such as surgery referrals and are not a good substitute for a trans-knowledgeable family doctor. 

Note on Accessing HRT as a Minor

Unfortunately, minors can experience even more gatekeeping and challenges with access to HRT than adults. Patients under 18 will almost always be asked by doctors to provide a minimum of 1 document from a mental health professional to access HRT, and sometimes more. Most clinics will also require parental consent (even though informed consent should apply for minors of age 14+). Youth under 16 will often be encouraged to take puberty blockers before starting HRT. Being familiar with the WPATH standards for HRT adolescents can help you push back against a doctor who requires ridiculous documents for you to start HRT (for example: a full psychiatric evaluation). You may consider literally showing up with a printed copy in hand, or a copy on your phone with the highlighted relevant sections. In our experience, often doctors who ask for ridiculous documentation will ask for it less out of a strong principle and more out of ‘cautious ignorance’. That said, while advocating for yourself can definitely help, if your doctor is unmoving it is unfortunately ultimately at your doctor’s discretion if they want to require those documents or not. 

Strategy 1: Get on the Family doctor waitlist for a trans-friendly GP

While the family doctor wait in Montreal is notoriously long and awful, if you have a RAMQ card and you call the guichet d’accès à un médecin de famille (here) and

Identify yourself as a trans person trying to access HRT or other gender-affirming care, you will be placed on a priority stream to be connected to a family doctor who understands HRT. This is because requiring gender-affirming care, like having a health condition, puts a patient on a priority stream for a family doctor.  

We have spoken to patients who have been able to effectively access HRT doctors this way in a matter of months.

If you already have a family doctor but they are unwilling to prescribe you HRT, you are unfortunately not able to be put on the family doctor waitlist. You would need to officially end your relationship with your family doctor to be added to the list, which is generally not advisable. 

Strategy 2: Call clinics and get on (many!) waitlists

Call clinics with providers that offer HRT and ask to be added to their waitlists. It is NOT necessary to get a referral from a family doctor or get a gender dysphoria diagnosis to go to a clinic with HRT providers (although some doctors might choose to refuse to see patients who have not had a diagnosis). We recommend that patients get on as many waitlists as possible to maximize their chances of getting a call back reasonably quickly – even if a patient is on a dozen waitlists, it may take 6-12 months to hear back from just one of those clinics. 

It may also be difficult to get on waitlists in the first place. Clinics may not respond to phone calls or emails, or may not be adding new patients to their waitlists. Many patients understandably find this discouraging and exhausting – no patient should have to deal with a medical system that works this way. In light of this, we encourage patients to treat this process as a numbers game and cast as wide a net as possible. If possible, spend an afternoon or two with multiple phones (many clinics will leave patients on hold for a long time) and call up all the clinics you can. Also make a template email asking to be put on the clinics’ waitlist for HRT and send this out to all the clinics you can. If you contact a large number of places enough times, eventually you will have a spot on a few waitlists.

Also keep in mind that wait times are often not what they are advertised. Clinics may maintain a waitlist but not actually be working through it, or may lose track of patients on the waitlist. It’s a good idea to follow up every few months with clinics to make sure you are still on their waitlist. Alternatively, in the rare cases when a clinic gets a new HRT provider they may clear through their waitlist overnight. For this reason even if a clinic has a long waitlist it’s worth being on it if possible. 

Finding a Provider

The TPU maintains a megalist of gender affirming clinics in the city which allows patients to cast the widest net possible. There are also other providers who will provide HRT but are not at a clinic generally known to provide HRT, and so they are harder to find and will likely have shorter wait times as a result. 

Unfortunately, in our experience, one of the most effective ways to access HRT quickly is to mobilize personal and community trans networks to get information about clinics that are accepting new patients. If possible, we suggest asking around in your networks – if you have any trans friends or acquaintances, they may know of clinics taking new patients – maybe a friend recently found a HRT provider, and that clinic or doctor may still be accepting patients.

Strategy 3: Are you a student? Visit a university or CEGEP clinic

For university or CEGEP students, the health clinic associated with their school can be a path to HRT access. The wait time for these clinics and doctors is often much shorter, but there can be unique logistical challenges.

Students nearing graduation should begin the process of migrating to the public or private system as soon as possible before they graduate, to avoid interruptions in care from no longer having access to their university clinic post-graduation.

McGill University

The McGill Wellness Hub is open to undergraduate and graduate students at McGill (but not non-student employees). The TPU is engaged in advocacy at the McGill Wellness Hub and we have this complete guide to HRT for McGill students.

Concordia University

The main doctor for trans healthcare in the Concordia student health centre is AJ Rubineau. She has been providing trans healthcare since 2017. She is going on sabbatical in June 2025 for a year and it is currently unclear who will take over trans healthcare at Concordia in her absence. 

There is typically a wait time of approximately 1-2 months for an appointment with Dr. Rubineau after contacting the Student Health Centre. It is important to note that Dr. Rubineau will not initiate treatment if a student is nearing graduation, as she will be unable to conduct follow-up appointments post-graduation.

Strategy 4: Going to a family doctor or family medicine clinic

Some family doctors are willing to provide HRT, which can be a way to avoid long waitlists at specialty clinics. 

Family doctors are legally and medically allowed to prescribe HRT, but many family doctors are unwilling to furnish this type of care and prefer to refer trans patients to specialists or other doctors. Many doctors feel unprepared to offer this type of care (trans health care is often taught inadequately or skipped entirely in med school and residency), or they may worry that a patient needs some kind of diagnosis to be prescribed hormones. While the chance of a family doctor being ignorant of the complexities of HRT is probably higher than if it is provided by a specialist, an informed family doctor is completely capable of providing and monitoring HRT.

Sometimes if patients are firm, convincing, and very well informed about what HRT care entails (ex: understand what doses of HRT they should start on, arrive to appointments with model consent forms, understand what types of blood tests they will need) they may be able to convince a family doctor who knows nothing about HRT to prescribe HRT by effectively walking them through the process, especially if the patient emphasizes that they have no other path to HRT do to extra long wait times. Obviously this will not work on numerous doctors, but occasionally patients are successful with this method. 

Whether or not you’re receiving gender-affirming medical care from your family doctor, it’s important to be informed about how trans health care works so that you’re able to advocate for yourself (see preamble above). 

Strategy 5: Going Private

Private clinics can offer much shorter wait times than public clinics to access HRT, but care is generally expensive. For example, Dr. Gabrielle Landry, a popular private provider for HRT, charges approximately $400 for the first appointment and $150-250 for follow-up appointments. However, if you have the money (or insurance that covers private care), private clinics often offer competent and relatively fast care. Although, private HRT patients often describe feeling rushed by private providers. 

If you have access to insurance for private clinics, you will probably need to pay upfront and wait for reimbursement later; claims can take a long time to process or and can be denied. Blood test forms from private doctors can be taken to public blood testing facilities. Despite the cost, private care can lead to HRT access much more quickly than the public system, making it an attractive option for patients with who can afford it. 

Telehealth services such as Maple and Dialogue offer another route to private appointments. While telehealth doctors typically do not prescribe HRT remotely, they can book in-clinic appointments through a concierge service.

Strategy 6: DIY

While lack of access to clinical care is not the only reason individuals use DIY HRT, and no one should have to DIY just because they cannot access clinical care, it is undeniable that many HRT patients self-medicate when they cannot access clinical care. 

DIY can come with unique drawbacks:

• Being unable to monitor hormone levels without blood tests
• Difficulty accessing the same administration method consistently depending on the suppliersy (pills, injections, etc)
• Challenges finding and maintaining the correct dosage
• Inability to get fertility preservation before beginning HRT 
• Safety & quality of gray/black market products
• Legal risks associated with manufacturing, importing, purchasing, or selling, especially for testosterone which is a controlled substance. Although enforcement is very rare.
• Depending on your supplier, it may be more expensive than getting HRT covered by RAMQ or another insurance. 
• Anxiety over taking on the responsibility of ensuring you are researching your care properly and the quality of sourced materials. 

But also comes with unique advantages: 

• Complete control, independence, and autonomy over your HRT, especially valuable to those who want HRT their doctors cannot or will not provide such as specific esters or non-standard anti-androgens. 
• You can begin at any time, within days if you order online or sooner if your supplier is local. 
• With careful expertise and research you can cater your HRT regimen to your body and needs beyond what some doctors are willing to facilitate. 
• Avoid any risks of providers gatekeeping care based on your gender identity or other factors. 
• Avoid any risks of transphobic or belittling encounters with health providers. 
• Avoid being precariously tied to one health professional in a specific city or country. 
• Complete anonymity (if done online)
• When done in an in-person local DIY community, it can be part of a larger network of trans solidarity, support, and community. 

However, safer practices and resources can help mitigate risks:

• There are DIY guides and trans science guides online which teach patients the science and process for DIY HRT. It’s best to educate yourself a LOT on the science behind HRT and the hormones you intend to take.
• Read reviews and grading scales to find reliable products and suppliers (ex: DIYHRT.cafe and eroids.com)
• If applicable, use clean injection supplies (CAMI, p10 & many other organizations provide these, you can also purchase them at pharmacies or from online pharmaceutical retailers for very cheap)
• Get blood tests to monitor your levels and for other health complications (although these are relatively rare, they can happen)
• If possible, connect yourself with the local DIY HRT community for peer support and testimonies from other DIYers about which DIY homebrewers they have had good experiences with. Many DIYers find these communities to be invaluable to their DIY journeys, although even in Montreal they can be hard to find if you are not already well connected to your local trans/queer mutual aid community, as it requires being connected primarily through word-of-mouth. 

Some DIYers use friends’ prescriptions (even though it is illegal to give someone else your prescription medication) to get access to a consistent, medical grade product without having to interact with grey/black markets. This can be a more approachable method for many new to HRT to DIY until they get to the front of a clinics’ wait list. It does of course mean your HRT access is tied to this person and you having a good relationship with them. This makes this method a less than ideal long term solution, as you risk losing access to your HRT if the person providing you their prescription moves or you have a falling out. 

As the amount of HRT prescribed varies so much between patients, if a patient lowers the dose of HRT they take for a few weeks before their next blood test, their blood test will come back with low hormone levels, and they can typically get providers to increase their dose. Some patients use this method to stock-pile HRT or share it with others who lack provider access. 

In Canada, feminizing hormones are legal to possess, but illegal to traffic, produce, import, or export, however seizure and prosecution is practically unheard of  (also sellers often offer refunds or reshipments if it happens). Testosterone, on the other hand, is a schedule IV substance under the Controlled Drugs and Substances Act (CDSA) and so carries much heavier legal repercussions for trafficking, producing, importing, exporting, or purchasing. That said, testosterone is not explicitly illegal to possess in Canada, unlike in many other countries such as the USA. 

For more resources on DIY, check out our list of DIY resources.

Getting a letter of recommendation from a mental-health professional (if necessary)

According to good gender-affirming care practices which featured informed consent, you should not need a letter of recommendation to access HRT. However, some doctors may still insist that patients require them. While we recommend finding a doctor that uses an informed consent approach if possible, if your best option for accessing HRT is to get a letter of recommendation, there are many mental health professionals who are generally open to writing them, often after only one or two appointments. We maintain a resource which includes a list of psychologists who write letters here. If you are already seeing a mental health professional and they are open to writing a recommendation letter, but aren’t sure what it should include, this website has a sample letter template for HRT.

In reaching out to mental health professionals for a recommendation letter, we recommend you be straight to the point that you are not interested in ongoing counseling and just a recommendation letter or gender dysphoria diagnosis to access HRT. Be sure to ask how many appointments this typically requires. A sensible mental health professional should understand the diagnosis/letter is mostly an inconvenient formality and should be able to provide it to you in one or two appointments. If the professional seems like they may drag you on for three, four, or more appointments, they are wasting your time and money.